Risk factors for chronic kidney disease in middle eastern patients with type 2 diabetes mellitus: A cross-sectional study using the KDIGO classification.

AIMS: Chronic kidney disease (CKD) is prevalent in patients with type 2 diabetes mellitus (T2DM). This study aimed to investigate risk factors for CKD progression across the kidney disease-Improving Global Outcomes (KDIGO)categories in a Middle Eastern population beyond hyperglycemia as emphasized by KDIGO guidelines which classifying CKD by cause and severity. METHODS: This cross-sectional study targeted 1603 patients with T2DM. Risk factors for CKD progression were determined using odds ratios (ORs) and 95 % confidence intervals (CIs). RESULTS: Overall, 35.5 %, 31.7 %, and 32.8 % of patients were classified as low-risk, moderate-risk, and high-/very high-/highest-risk, respectively. Several factors were associated with high/very high/highest risk categorization, including being aged >45 years (OR: 1.85, 95 % CI: 1.36-2.49; P < 0.001), male gender (OR: 1.87, 95 % CI: 1.38-2.54; P < 0.001), hypertension (OR: 3.66, 95 % CI: 2.32-5.78; P < 0.001), and T2DM duration of ≥15 years (OR: 3.2, 95 % CI: 2.27-4.5; P < 0.001). Patients with more concurrent risk factors were notably represented in the high/very high/highest risk category. CONCLUSIONS: Male patients, older patients, and those with comorbid hypertension, longstanding T2DM, and additional concurrent risk factors have a significantly higher risk of advanced CKD. Such findings should be considered when planning management approaches for patients with CKD.

Differential changes in maternal proinflammatory IL6 plasmalevels as a putatively surrogate marker of candidacy andclinical utility during mid- and late pregnancy hyperglycemia:interventional impact of clinical pharmacist on maternal andneonatal outcomes in a randomized clinical trial / Cambios diferenciales en los niveles plasmáticos de IL6 proinflamatoria materna como un marcador supuestamente sustituto de candidatura y utilidad clínica durante la hiperglucemia a mitad y final del embarazo: impacto intervencionista del farmacéutico clínico en los resultados maternos y neonatales en un ensayo clínico aleatorizado

Background/methods: The impact of clinical pharmacist on undiagnosed pregnancy hyperglycemia (PHG) in mid- and late- pregnancy as a major preventable cause of maternal and neonatal (M/N) complications is investigated. This longitudinal randomized controlled study of changes in plasma levels of predictive/prognostic/diagnostic biomarkers of oxytocin, thrombospondin, MCP1, IL6, MIF, insulin and LAR and undesirable M/N pregnancy outcomes in women with/out PHG (pregnancy normoglycemia; PNG) following the implementation of clinical pharmacist interventions were investigated. Results: A total of 68 PHG (36 intervention vs. 32 non-intervention) vs. 21 PNG participants were enrolled at 20–28 weeks and followed up till delivery. BMI of intervention PHG (unlike non-intervention) was greater (p=0.036) compared to PNG’s. LAR and insulin, oxytocin, thrombospondin1, adiponectin and MCP1 plasma levels and their differences between 2nd and 3rd pregnancy trimesters lacked discrepancies in participants. Both PHG groups in mid pregnancy had substantially greater HbA1c %, FPG and IL6 levels vs. PNG, while PHG non-intervention’ leptin was greater than PNG’s. In late pregnancy, greater SBP, IL6 and MIF levels between either PHG groups vs. PNG’s were observed. Unlike PHG non-intervention and PNG; IL6 level in PHG intervention group decreased (-2.54±6.61; vs. non-intervention PHG’s 4.26±5.28; p<0.001 and vs. PNG’s 2.30±4.27; p=0.023). None of the assessed M/N outcomes was found of differential significance between any of the three study groups. Conclusions: Proinflammatory IL6 as a robust and generalizable cardiometabolic risk-based and related pharmacotherapy biomarker in mid and late hyperglycemic pregnancy with likely implications of novel therapeutic targets was delineated by clinical pharmacist interventions.(AU)

The prevalence of overactive bladder and its impact on the quality of life: A cross-sectional study.

Objective: Overactive bladder (OAB) is a common condition affecting both men and women and has been shown to affect the quality of life. We conducted this study to estimate the prevalence of OAB, and to incorporate symptom severity, symptom bother and health-related quality of life (HRQL) in the assessment of OAB and evaluate associated factors. Methodology: A total of 940 participants were categorized into non-OAB and OAB using the Overactive Bladder Symptom Score (OABSS). HRQL and symptom bother were measured using the Overactive Bladder Questionnaire - Short Form (OAB-q SF). Descriptive analyses and multivariable regression analyses were performed. Results: The prevalence of OAB among our population was 27.4%. Patients with older age (Odd ratio [OR] = 2.26, 95% confidence interval [CI]: 1.6-3), higher body mass index (BMI) (OR = 2.6, 95% CI: 1.8-3.8), comorbidities (OR = 2.6, 95% CI: 1.9-3.5) and history of recurrent urinary tract infection (UTI) s (OR = 1.9, 95% CI: 1.4-2.6) were significantly associated with increased risk of OAB (p < 0.001). The mean OAB symptom bothers score was 35.7 + 22.9 and increased significantly across OAB severity groups (p < 0.001). The mean HRQL score was 73.3 + 22 and a significant decreased across OAB severity groups (p < 0.001). All OAB symptoms showed significant positive correlation with increased symptom bother (p < 0.001) in addition to significant inverse correlation with HRQL (p < 0.001). Conclusion: OAB is a prevalent condition in our population and the associated symptoms negatively affect HRQL. In this study, the detrimental effect is not exclusive to UUI and can be attributed to the other elements in the symptom spectrum of OAB. Screening for OAB should be considered during routine clinical visits using validated and reliable measures for early detection of symptoms and possible modification of risk factors to improve the outcome.

Degenerative lumbar changes have a statistically significant but small effect on trabecular bone score (TBS)-adjusted fracture risk (FRAX).

Trabecular bone score (TBS) assesses trabecular microarchitecture at the lumbar spine and was shown to improve fracture risk prediction compared to bone mineral density (BMD) alone. We investigated whether lumbar degenerative changes (DC) affect TBS and TBS-adjusted 10-year fracture risk assessment (tool) (FRAX) estimates. All patients who underwent BMD and TBS measurements via dual-energy X-ray absorptiometry at our institution between 1/7/2020 and 1/10/2020 were retrospectively evaluated. We identified all patients who had DC in 1 or 2 vertebrae (out of L1-L4) with a BMD T score > 1 unit higher than the remaining 2 to 3 adjacent vertebrae. TBS and BMD were compared between the vertebrae with and without DC. Change in TBS as well as FRAX estimates for major osteoporotic (MOP) and hip fractures after exclusion of the degenerative vertebrae were also determined. Of the 356 eligible patients, 94 met the inclusion criteria. The mean TBS of vertebrae without DC was not significantly different from that of L1 to L4 (1.31 ± 0.12 vs 1.32 ± 0.12, respectively, P = .11). The FRAX estimates after exclusion of the degenerative vertebrae were statistically significantly higher than for L1 to L4 for both MOP and hip fractures (P = .04 and P = .01, respectively). However, the differences were very small. The mean 10-year MOP FRAX estimate after exclusion of degenerative vertebrae was 7.67% ± 4.50% versus 7.55% ± 4.36% for L1 to L4 and the mean 10-year hip FRAX estimate after exclusion of degenerative vertebrae was 2.06% ± 2.01% versus 2.02% ± 1.98% for L1 to L4. Lumbar DC have a statistically significant but only small effect on TBS-adjusted FRAX making it unnecessary to exclude the degenerative vertebrae when computing TBS.

Post-COVID-19 syndrome among healthcare workers in Jordan.

Background: Post-COVID-19 syndrome covers a wide range of new, recurring or ongoing health conditions, which can occur in anyone who has recovered from COVID-19. The condition may affect multiple systems and organs. Aims: To evaluate the frequency and nature of persistent COVID-19 symptoms among healthcare providers in Jordan. Methods: Post-COVID-19 syndrome refers to symptoms extending beyond 4-12 weeks. We conducted a historical cohort study among 140 healthcare staff employed at the National Center for Diabetes, Endocrinology and Genetics, Amman, Jordan. All of them had been infected with COVID-19 virus during March 2020 to February 2022. Data were collected through face-to-face interviews using a structured questionnaire. Results: Some 59.3% of the study population reported more than 1 persisting COVID-19 symptom, and among them 97.5%, 62.6% and 40.9% reported more than 1 COVID-19 symptom at 1-3, 3-6 and 6-12 months, respectively, after the acute phase of the infection. Post-COVID-19 syndrome was more prevalent among females than males (79.5% vs 20.5%) (P = 0.006). The most frequent reported symptom was fatigue. Females scored higher on the Fatigue Assessment Scale than males [23.26, standard deviation (SD) 8.00 vs 17.53, SD 5.40] (P < 0.001). No significant cognitive impairment was detected using the Mini-Mental State Examination and the Montreal Cognitive Assessment scales. Conclusion: More than half (59.3%) of the healthcare workers in our study reported post-COVID-19 syndrome. Further studies are needed to better understand the frequency and severity of the syndrome among different population groups.

The prevalence of diabetes distress among patients with type 2 diabetes in Jordan.

Objectives: Diabetes distress (DD) is a state of emotional distress that evolves from living with chronic disease and the burden of daily adjustments of medications and lifestyle. This study investigated the prevalence of DD in patients with type 2 diabetes mellitus (T2DM) in Jordan and the related sociodemographic and medical factors. Methods: We conducted a cross-sectional study in 608 patients with T2DM in Jordan, ranging from ages 15 to 80 years. The participants filled out a questionnaire where they were asked to self-assess their DD using the Diabetes Distress Scale. In all, 32 participants were excluded according to the exclusion criteria, which resulted in 576 people being included in this study. Results: The overall prevalence of DD was 53% (25% had moderate distress and 28% had high distress). Emotional distress had the highest prevalence among the DD subscales, with a total prevalence of 58.8%. The data showed a significant association of DD with different factors including age, the presence of diabetic complications, the type of medication used, and medication adherence. Conclusion: This study showed a high prevalence of DD (53%). This finding should raise awareness to healthcare providers about the importance of screening for DD as part of the treatment guidelines, especially in patients who are on multiple medication regimens for DM; patients who have previous medical complications related to DM; and those who exhibit poor adherence to medications, which was found to be a risk factor of DD in this study.

Control of diabetes, hypertension, and dyslipidemia in Jordan: a cross-sectional study.

To determine the level of glycemic, blood pressure (BP), and lipids control among patients with type 2 diabetes mellitus (DM) attending the National Center for Diabetes, Endocrinology and Genetics and to determine factors associated with poor control. Methods: A cross-sectional study of 1200 Jordanian type 2 DM patients was included in this study during the period of December 2017-December 2018. We reviewed the charts of these patients until January 2020. Data obtained from medical records included information about sociodemographic variables, anthropometric measurements, glycated hemoglobin (HbA1c), BP, low-density lipoprotein (LDL), the presence of DM complications, and treatment. Results: The percentage of subjects who had HbA1c values of less than 7% was 41.7%. BP targets (<140/90 and 130/80 mmHg) were achieved in 61.9 and 22% of our patients, respectively. LDL targets less than 100 and 70 mg/dl or less were achieved in 52.2 and 15.9% of our studied population. Only 15.4% of our patients could have simultaneous control of HbA1c less than 7%, BP less than 140/90 mmHg, and LDL less than 100 mg/dl. Factors associated with poor glycemic control were obesity [odds ratio (OR)=1.9], DM duration between 5 and 10 years or more than 10 years (OR=1.8 and 2.5, respectively), and the use of a combination of oral hypoglycemic agent plus insulin or insulin alone (OR=2.4 and 6.2, respectively). Moreover, factors associated with uncontrolled BP (≥140/90) were male gender (OR=1.4), age 50-59 years or at least 60 years (OR=3.3 and 6.6, respectively), overweight and obesity (OR=1.6 and 1.4, respectively), insulin use (OR=1.6), and LDL at least 100 mg/dl (OR=1.4). Conclusion: The overall prevalence of poor glycemic control was high and alarming. Future research should focus on capturing all variables that may impact glycemic, BP, and dyslipidemia control, with special emphasis on a healthy lifestyle that would be of great benefit in this control.

Dyslipidemia among patients with type 2 diabetes in Jordan: Prevalence, pattern, and associated factors.

Objectives: To determine the prevalence and patterns of dyslipidemia and its associated risk factors among patients with type 2 diabetes attending the National Center for Diabetes, Endocrinology, and Genetics (NCDEG). Methods: A cross-sectional study was conducted at the NCDEG in Amman, Jordan. A total of 971 patients with type 2 diabetes were included during the period September- December 2021. The socio-demographic data were collected through face-to-face interview questionnaire and anthropometric and clinical data were abstracted from medical records. The last three readings of lipid profile and HbA1C were abstracted from the medical records. Results: The overall prevalence of dyslipidemia among type 2 diabetic patients was 95.4%. The most common type of dyslipidemia was combined dyslipidemia (37.1%), with high triglycerides and low HDL-c (19.0%) being the most frequent type. Factors associated with hypercholesterolemia were diabetes duration ≤ 10 years, poor compliance to a statin, and HbA1c level (7-8%) (P-values: 0.008, 0.001, 0.021, respectively). Moreover, smoking and poor compliance with statin therapy were associated with high LDL-c level (P-values: 0.046 and 0.001, respectively). The presence of hypertension, high waist circumference, HbA1c level >8%, and diabetes duration ≤ 10 years were all associated with high triglyceride level (P-values: 0.008, 0.016, 0.011, and 0.018, respectively). Hypertension and HbA1c level >8% were associated with low HDL-c level (P-values: 0.010 and 0.011, respectively). Conclusion: The combination of high triglyceride and low HDL-c is the commonest lipid abnormality detected in patients with type 2 diabetes. An educational program that emphasizes the importance of adherence to a healthy lifestyle is strongly recommended. Further studies are needed to capture a wide range of factors that might influence dyslipidemia and glycemic control.

Prevalence and Correlates of Hypophosphatemia Among Type 2 diabetic patients attending the National Center for Diabetes, Endocrinology and genetics (NCDEG).

Objectives: To estimate the prevalence of hypophosphatemia and its associated factors among type 2 diabetic patients attending (NCDEG) in Amman-Jordan, and compare the prevalence of hypophosphatemia between diabetics, nondiabetic subjects. Patients and methods: A case-control study was carried out at (NCDEG). A total of 1580 diabetic patients (59.7% females, 40.3% males), mean age (SD) of 55.15 ± 15.3 attended this center from January 1st, 2020 till March 31st, 2020 were included. Our study included 2155 non-diabetic from the national population-based multipurpose study in Jordan in 2017, to compare serum inorganic phosphate between diabetic, nondiabetic. Pregnant, those aged <18 or >80 years, GFR below 30 ml/min or those on hemodialysis were excluded. The data included patient's age, gender, smoking and medication, HbA1c. Statistical analysis were performed using the Package for Social Sciences (SPSS) version 21. Results: The overall prevalence of hypophosphatemia in the diabetic patients was significantly higher (10.5% vs. 3.2%, P-value 0.001). Multivariate logistic regression analysis showed that in diabetic: males, current smokers, diabetic patients with HbA1c between 7 and 9% and >9%, those who on thiazide diuretics were 2, 1.9, 1.8, 1.7, and 1.9 times, more likely to have hypophosphatemia than their counterparts (P-values 0.001, 0.001, 0.006, 0.018 and 0.003), respectively, and it was found those on statin were less likely to have hypophosphatemia. Conclusion: The prevalence of hypophosphatemia among type 2 diabetic patients is high. Factors independently related to hypophosphatemia in diabetic patients: male gender, smoking, poor glycemic control, taking thiazides and not being on statin.

Effectiveness of carbohydrate counting and Dietary Approach to Stop Hypertension dietary intervention on managing Gestational Diabetes Mellitus among pregnant women who used metformin: A randomized controlled clinical trial.

BACKGROUND: Gestational diabetes mellitus (GDM) is one of the most common complication of pregnancy that has significant impacts on both mother and her offspring health. The present study aimed to examine the effect of carbohydrate counting, carbohydrate counting combined with DASH, and control dietary interventions on glycemic control, and maternal and neonatal outcomes. METHODS: A total of 75 pregnant women with GDM at 24th - 30th week of gestation were enrolled and randomized to follow one of the three diets: control or carbohydrate counting, or carbohydrate counting combined with Dietary Approach to Stop Hypertension (DASH). Only 70 of them completed the study until delivery. Fasting blood samples were taken at baseline and the end of the study to measure fasting blood glucose (FBG), fasting insulin, glycated hemoglobin (HbA1c), and fructosamine. Homeostatic model assessment-insulin resistance (HOMA-IR) score was calculated using HOMA2 calculator program. The participants recorded at least four blood glucose readings per day. Maternal and neonatal outcomes were collected from medical records. Dietary intake was assessed by three-day food records at the baseline and the end of the study. RESULTS: Adherence to the three dietary interventions, resulted in decreased FBG levels significantly among all the participants (P < 0.05). Consumption of the carbohydrate counting combined with the DASH diet showed significant reduction in serum insulin levels and HOMA-IR score compared to carbohydrate counting group and control group. Means of fructosamine and HbA1c did not differ significantly among the three intervention diet groups. Overall mean of 1-h postprandial glucose (1 h PG) level was significantly lower in the carbohydrate counting combined with DASH group compared with that in the carbohydrate counting group and the control group (P < 0.001). The number of women who were required to commence insulin therapy after dietary intervention was significantly lower in carbohydrate counting group and carbohydrate counting combined with DASH group (P = 0.026). There were no significant differences in other maternal and neonatal outcomes among the three dietary intervention groups. CONCLUSIONS: The carbohydrate counting and the carbohydrate counting combined with DASH dietary interventions resulted in beneficial effects on FBG and 1 h PG compared with the control diet. The three dietary interventions produced similar maternal and neonatal outcomes in women with GDM. TRIAL REGISTRATION: This trial was registered on ClinicalTrials.gov under the identification code: NCT03244579. https://clinicaltrials.gov/ct2/show/NCT03244579.

The prevalence of hypertension and its progression among patients with type 2 diabetes in Jordan.

BACKGROUND: Assessing the prevalence and progression of hypertension among diabetics is crucial for designing appropriate strategies for successfully managing hypertension and its life-threatening complications. This study aimed to assess the prevalence of hypertension, its progression, and its determinants among type 2 diabetes mellitus (T2DM) patients in Jordan. MATERIALS AND METHODS: A cross-sectional study was conducted among 1382 Jordanian patients with T2DM in the period from January 2019 to January 2020. Blood pressure (BP) was followed and measured every 2-3 months using standardized automated sphygmomanometer during patients' routine visits for a total of 12 months. Data were obtained from medical records that included sociodemographic variables, anthropometric measurements, HbA1c, lipid profile, presence of T2DM complications and treatment. RESULTS: The prevalence of hypertension among T2DM patients at the baseline was 74.6% (95% CI: 72.2%, 76.9%). The one-year incidence of hypertension among T2DM patients who were free of hypertension at the baseline was 26.2% (95% CI: 21.7%, 31.1%). In the multiple logistics regression analysis, patients older than 60 years (OR = 1.3 (95% CI: 1.01, 1.7); p-value 0.045) and those with positive family history of hypertension (OR = 4.2 (95% CI: 1.2, 8.2); p-value 0.026) were more likely to have uncontrolled hypertension. Patients who were using insulin only were less likely (OR = 0.5 (95% CI: 0.2, 0.9); p-value 0.026) to have uncontrolled hypertension compared to those who were on oral hypoglycemic agents only. CONCLUSION: The prevalence of hypertension among Jordanian patients with T2DM is alarmingly high. Healthcare providers should be committed to policies or preventive strategies targeting the modifiable risk factors associated with hypertension.

Effect of Metformin on Anthropometric Measurements and Hormonal and Biochemical Profile in Patients with Prediabetes.

OBJECTIVES: Metformin is the most widely preferred first-line oral antidiabetic agent that results in clear benefits in blood sugar regulation and diabetes-related complications. This study is aimed at assessing the effect of metformin on anthropometric, hormonal, and biochemical parameters in patients with prediabetes or insulin resistance. METHODS: A prepoststudy was conducted among 52 patients with prediabetes or insulin resistance who met the inclusion criteria. Weight, body mass index (BMI), and waist circumference were measured before and 12 months after metformin treatment. Serum concentrations of sex steroids, gonadotropins, and lipids were also assessed. Homeostasis model assessment (HOMA) index and quantitative sensitivity check (QUICKI) index scores were calculated before metformin treatment and after 12 months of use. RESULTS: After 12 months of metformin treatment, female patients had significant reduction in weight, BMI, and waist circumference after adjusting for age. Metformin use for 12 months resulted in significant reduction in mean fasting blood glucose and HbA1c in females only. Total cholesterol decreased significantly among men only and serum HDL-C showed a significant rise among females only. Serum LDL-C and triglycerides did not change significantly in females and males. Our study did now significant changes in ACTH and cortisol levels in both females and males after metformin treatment. Metformin use resulted in significant increase in luteinizing hormone (LH) and progesterone levels in males, while it was associated with significant increase in prolactin, follicular stimulating hormone (FSH), and dehydroepiandrostenedione-sulphate (DHEA-S) levels and significant decrease in total testosterone level in females. CONCLUSION: Metformin treatment in females with prediabetes reduces BMI, waist circumference, fasting blood glucose, and HbA1c. The changes in the studied parameters differed significantly according to sex.

Exploring variables associated with medication non-adherence in patients with type 2 diabetes mellitus.

OBJECTIVE: This study aims to assess medication adherence and explore its predictors in outpatients with type 2 diabetes. METHOD: This cross-sectional study collected socio-demographics, disease-related information, and different biomedical variables for type 2 diabetes patients attending a Jordanian Diabetes center. The four-item medication adherence scale (4-IMAS) and the beliefs about medications questionnaire (BMQ) which includes necessity and concerns were used. Stepwise backward quartile regression models were conducted to evaluate variables associated with the Necessity and Concerns scores. Stepwise ordinal regression was conducted to evaluate variables associated with adherence. RESULTS: 287 diabetic patients participated in the study. Almost half of the participants (46.5%) reported moderate adherence and 12.2% reported low adherence. Significant predictors of the adherence were necessity score (OR = 14.86, p <0.01), concern score (OR = 0.36, p <0.05), and frequency of medication administration (OR = 0.88, p- <0.01). Education was a significant predictor of Necessity and Concerns scores (ß = 0.48, -0.2, respectively). CONCLUSION: Simplifying the medication regimen, emphasizing medication necessity and overcoming medication concerns should be targeted in future diabetes intervention programs to improve medication adherence and hence glycemic control among diabetic patients.

The Frequency and Risk Factors of Diabetic Foot Ulcer Recurrence Among Jordanian Patients with Diabetes.

BACKGROUND: Diabetic foot is a major public health problem and their complications are an imperative cause of morbidity and mortality in diabetes. OBJECTIVE: To evaluate the rate of recurrence of foot ulcers post two years of follow-up, including the associated risk factors in the patients attending the diabetic foot clinic at the National Center for Diabetes, Endocrinology, and Genetics (NCDEG), Amman, Jordan. METHODS: A historical cohort design was adopted for the patients who presented for the first time to the diabetic foot clinic at the NCDEG. Every patient who came to the clinic was reviewed by using his or her medical files with respect to diabetic foot-related complaints. Patients were classified under four categories: (1) Recurrent foot ulcers (2) chronic foot ulcer (3) free of recurrence, and (4) no foot ulcers. Among the four groups, group 1 (recurrent foot ulcers, n=76) and group 3 (free of recurrence, n=54) were included for the analysis. RESULTS: Among the 141 patients who presented to the diabetic foot clinic during the two-year study period, 76 (53.9%) of them experienced ulcer recurrences, 54 (38.3%) were recurrence-free, and 11 (7.8%) had chronic ulceration. The two-year recurrence rate was 58.5%. The presence of deformity and osteomyelitis were the statistically significant independent risk factors for recurrent foot ulceration. CONCLUSION: This study of recurrences was clearly related to the type and complications of the ulcers rather than to the other variables. Recurrent foot ulceration is linked to the presence of osteomyelitis and/or deformities.

Insulin Sensitivity Indices in Patients with Polycystic Ovary Syndrome with Different Body Mass Index Categories.

OBJECTIVE: This study aimed to determine the prevalence of insulin resistance among women with polycystic ovary syndrome (PCOS), describe the clinical and biochemical characteristics of women with PCOS, and determine the association between Antimullerian Hormone (AMH) and PCOS. PATIENTS AND METHODS: In a clinical case series, 544 women with PCOS were included in this study. Body mass index (BMI), Homeostasis Model Assessment (HOMA), Quantitative Insulin Sensitivity Check Index (QUICKI), and Matsuda index were calculated. Sixty-three women with PCOS and 50 age- and BMI-matched control patients underwent blood sampling for AMH level. RESULTS: The most common clinical presentation of PCOS in this study was menstrual irregularity followed by hirsutism and infertility. There was no statistically significant difference in the clinical presentation or hormonal profile in women with PCOS according to different BMI categories. The prevalence of insulin resistance among women with PCOS was 37.7%, 69.3%, and 75.8% using HOMA, QUICKI, and Matsuda index, respectively. Furthermore, the Matsuda index had the highest detection rate of insulin resistance, especially in underweight women with PCOS (94.1%). AMH levels in women with PCOS were significantly higher than that in the control group (P-value = 0.015). CONCLUSION: Insulin resistance is prevalent among women with PCOS. The detection rate of insulin resistance varies according to the insulin sensitivity index used. Menstrual irregularity was the most common presentation of PCOS. Women with PCOS have significantly higher levels of AMH levels compared to women in the control group.

Hypertension in Jordan: Prevalence, Awareness, Control, and Its Associated Factors.

OBJECTIVES: Determine the prevalence, awareness, and control rates of hypertension and their associated factors among Jordanian adults. METHODS: A multistage sampling technique was used to select a nationally representative sample of adults from the population of Jordan. Trained interviewers collected data using a comprehensive structured questionnaire, measured anthropometric parameters, and collected blood samples. RESULTS: This study included a total of 1193 men and 2863 women aged ranged from 18 to 90 year with a mean (SD) of 43.8 (14.2) year. The age-standardized prevalence was 33.8% among men and 29.4% among women. Of those with hypertnsion, 57.7% of men and 62.5% of women were aware of hypertension. Only 30.7% of men and 35.1% of women who were on antihypertensive medications had their blood pressure controlled. From 2009 to 2017, there was nonsignificant decrease in hypertension prevalence of 2.7% among men and 1.1% among women. However, the rate of hypertension awareness increased significantly among men and among women. DISCUSSION: Almost one-third of Jordanian adults had hypertension. Interventions that target modifiable risk factors of hypertension, might decrease blood pressure, and even prevent the development of hypertension should be implemnted.

Factors Associated with Health-Related Quality of Life among Jordanian Patients with Diabetic Foot Ulcer.

OBJECTIVE: This study is aimed at determining factors associated with the quality of life among Jordanian diabetic patients with foot ulcers. METHODS: 144 consecutive patients with diabetic foot ulcers aged ≥ 18 years who were attending the diabetic foot clinic at a diabetes-specialized center were included in this study. Health-related quality of life was assessed using two self-administered questionnaires: Diabetic Foot Scale-Short Form (DFS-SF) and Short Form-8 (SF-8). RESULTS: Patients with diabetic foot ulcer had low mean DFS-SF score and low mean scores on physical and mental component summary scales (PCS8 and MCS8). Males had significantly higher DFS-SF score indicating better health-related quality of life than females (P value 0.038). A patient with stressful life events had significantly lower health-related quality of life using DFS-SF scale and SF-8 summary scales. Patients with peripheral vascular disease (PVD) and patients with obesity had lower DFS-SF and PCS8 quality of life. CONCLUSION: Patients with diabetic foot ulcer had low quality of life. Female gender, obesity, presence of PVD, and stressful life events were the most important factors associated with lower quality of life in patients with diabetic foot ulcer.

Vitamin D deficiency and associated factors in Jordan.

BACKGROUND: In Jordan, many studies reported various rates of vitamin D deficiency and insufficiency among different groups. This study aimed to determine the prevalence of low vitamin D level among Jordanian adults and determine its association with selected variables. METHODS: The vitamin D level was assessed in a national representative sample of 4056 subjects aged >17 years. The study involved face-to-face interviews with the subjects and measurement of serum 25(OH)D. Low vitamin D level was defined as 25(OH)D < 30 ng/mL. Deficiency was defined as 25(OH)D < 20 ng/mL, and insufficiency was defined as 25(OH)D level of 20-30 ng/mL. RESULTS: The overall prevalence of low vitamin D status (25(OH)D < 30 ng/mL) was 89.7%, with higher prevalence in males (92.4%) than in females (88.6%). Vitamin D was sufficient in 7.6% of males, insufficient in 38.4% of males, and deficient in 54% of males. Among females, vitamin D was insufficient in 10.1% and deficient in 78.5%. The prevalence of vitamin D deficiency was much higher in females than in males (p = 0.001). The only variables that were significantly associated with low level of vitamin D were gender, age, obesity, and employment. CONCLUSION: The prevalence of low vitamin D level is extremely high in Jordan. Age, gender, obesity, and unemployment were associated with low levels of vitamin D. Health authorities in Jordan need to increase the level of awareness about vitamin D deficiency and its prevention, particularly among women.

Use of multiple antidiabetic medications in patients with diabetes and its association with hypoglycaemic events: a case-crossover study in Jordan.

OBJECTIVE: To assess whether the use of multiple antidiabetic medications is associated with an increased risk of hypoglycaemia in patients with type 2 diabetes mellitus. DESIGN: A case-crossover study. SETTING: Cases were enrolled from the National Center for Diabetes, Endocrinology and Genetics in Amman, Jordan. PARTICIPANTS: Patients were those with diabetes mellitus and reported incident of a hypoglycaemic event in their medical records during the period January 2007 to July 2017. Patients with multiple antidiabetic medications were those with at least two antidiabetic medications. PRIMARY OUTCOME: History of antidiabetic medication use was extracted from the pharmacy records. The use of multiple antidiabetic medications during the risk window (before hypoglycaemia) was compared with a control window(s) (earlier time) of the same length after a washout period. Conditional logistic regression was applied to evaluate the OR of hypoglycaemia between the treatment groups. A secondary analysis was performed in patients with a blood glucose measurement of ≤70 mg/dL. RESULTS: 182 patients (106 females, 58.2%) were included in the study with an average age of 59.9 years (SD=9.9). The patients' average body mass index was 31.7 kg/m2 (SD=6.2). Compared with monotherapy, the OR of hypoglycaemic events for patients with multiple antidiabetic medications was 5.00 (95% CI 1.10 to 22.82). The OR was 6.00 (95% CI 0.72 to 49.84) for the secondary analysis patient group (n=94). Ten-fold increased risk was found in patients (n=155) with insulin and sulfonylurea-based combination therapy (OR 10.00;95% CI 1.28 to 78.12). CONCLUSION: This study shows that the use of multiple antidiabetic medications appears to increase the risk of hypoglycaemic events. Patients and healthcare professionals should be extra vigilant when patients are on multiple antidiabetic medications therapy, especially the combination of sulfonylurea and insulin.

Impact of clinical pharmacists intervention on management of hyperglycemia in pregnancy in Jordan.

Background and objective Hyperglycemia in pregnancy is a risk factor for cardiovascular disease and postpartum (PP) diabetes. This study aimed to assess the impact of the clinical pharmacist-assisted program (CPAP) of optimizing drug therapy and intensive education on main management outcome measures of patient knowledge about diabetes, Quality of life (QoL) as measured by SF-36 including maternal complications, fasting plasma glucose (FPG) control, and HbA1c. Method This is a randomized controlled study. Pregnant (20-28 weeks) patients with hyperglycemia received CPAP (n = 51) as compared with conventional management (n = 34). Patients were then followed up for 6 weeks pp. Results A significant change was shown in the intervention group for diabetes knowledge (3.47% vs. control 2.03%, P < 0.05) and three aspects of health-related QoL. The need for caesarian delivery (58.8% vs. control 35.3%) and severe episodes of hypoglycemia (0% vs. control 8.8%) were significantly (P < 0.05) reduced in the intervention group. Six weeks PP reduction in HbA1c values was greater in the intervention group (- 0.54% vs. control - 0.08%, P = 0.04) with more FPG-controlled patients during pregnancy (94% vs. control 64.7%). Conclusion Clinical pharmacist assisted services in the management of pregnancy hyperglycemia fundamentally and significantly improve knowledge and disease control.