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BACKGROUND: Lifestyle modification interventions help prevent or postpone Type 2 Diabetes and its complications with diet modification and increasing physical activity. This is translational research of Tawazon-DPP in which we evaluate the efficacy of the intensive lifestyle modification program. METHODS: Tawazon was piloted in 2 phases over 6 and 9 months at a Tertiary Hospital. Phase I was conducted in 2017 in one district facility with 47 participants while Phase II was conducted in 2018 in 4 district facilities with 247 participants. Data are collected retrospectively in a before-and-after study design. The program included adults with 25 kg/m2 BMI and HbA1c ranging between 5.7 and 6.4 mmol/L, while excluding participants with comorbidities, such as cardiovascular conditions, musculoskeletal injuries, and pregnancy. RESULTS: We used descriptive analysis as well as Wilcoxon rank sign test and McNemar-Bowker for before and after data comparisons. Phase I exhibited a mean age of 43±7 years and statistically significant improvement in HbA1c (0.3 mmol/L), weight (3.3 kg), BMI (1 kg/m2), triglyceride (30.4 mg/dL) and LDL (14.67 mg/dL). Phase II exhibited a mean age of 45±9 years with 70% above 40 years old. Significant improvement was also found in HbA1c (0.2 mmol/L), weight (5.1 kg), and BMI (1.8 kg/m2); the lipid profile in the second phase showed better results with significant improvement in total cholesterol (7.4 mg/dL), triglyceride (20.9 mg/dL), LDL (8.8 mg/dL), and (0.9 mg/dL) increase in HDL. CONCLUSION: This pilot has taken lifestyle interventions to real-life and it led to the favored and desired outcome. It showed that long-term guided support can help patients make the needed changes in their diet, habits, and physical activity, thus, prevent or delay the onset of Type 2 diabetes.
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INTRODUCTION: The World Health Organization recommends essential measures to "combat drug resistance", including instituting surveillance "everywhere". Standardized metrics are crucial for reliable surveillance. Studies publish metrics with varying definitions for multi-drug resistant organisms (MDRO). The Society for Healthcare Epidemiology of America (SHEA) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) proposed standardized metrics for MDRO for consistent reporting, identifying high-risk groups, and evaluating interventions. METHODOLOGY: We retrieved 73 studies through PubMed using the search terms "methicillin-resistant Staphylococcus aureus", "MRSA", and "Saudi Arabia". We selected 20 studies that reported MRSA incidence or prevalence in patients and/or percentage among Staphylococcus aureus isolates and evaluated these metrics against the closest matching SHEA/HICPAC metrics. RESULTS: We outlined issues applicable to MRSA metrics such as comparison of risk-unadjusted metrics; their pooling for different hospitals; not accounting for post-discharge infections; non-specification of AST-based, and healthcare and community associated infections' related, standardized metrics by SHEA/HICPAC; and appropriate temporal criteria for nosocomial infections. We elaborated salient features of reviewed metrics versus their SHEA/HICPAC complements. Terminology and definitions of reviewed metrics differed from SHEA/HICPAC counterparts. Some did not satisfy the epidemiological or statistical criteria for their reported category; e.g. prevalence indicators were classified as incidence and vice versa. CONCLUSIONS: SHEA/HICPAC metrics would be useful for future studies. Our results show an imminent need for an international consensus on fundamental MDRO surveillance metrics; illustrate surveillance scenarios requiring standardized metrics; identify some indicators from Saudi studies supplementing SHEA/HICPAC metrics; and underscore SHEA/HICPAC's advice for avoiding comparison of risk-unadjusted metrics between hospitals.