Modern-Day Management of the Dysglycemic Continuum: An Expert Viewpoint from the Arabian Gulf.

Prediabetes is the first stage of a continuum that extends through the diagnosis of clinical type 2 diabetes towards long-standing diabetes with multiple comorbidities. The diagnosis of prediabetes provides an opportunity to interrupt the diabetes continuum at an early stage to ensure long-term optimization of clinical outcomes. All people with prediabetes should receive intervention to improve their lifestyles (quality of diet and level of physical activity), as this has been proven beyond doubt to reduce substantially the risk of conversion to diabetes.

The burden and clinical trajectory of immune checkpoint inhibitor-induced endocrinopathies: an 8-year experience.

Background: Immune checkpoint inhibitors (ICIs) have revolutionized the management of cancer patients, but the emergence of ICI-related endocrinopathies (IREs) has introduced new clinical challenges. Despite worldwide recognition of these adverse effects, data from the Middle East is scarce.

Methods: This retrospective-observational study included adult cancer patients who received at least one dose of ICI between January 2015 and January 2023.

Rapid Resolution of Recalcitrant Headache With Pasireotide in an Adult Patient With Acromegaly.

Acromegaly is a chronic hormonal disorder caused by excessive GH secretion. In addition to physiological symptoms, it is often accompanied by debilitating headaches. Although effective treatment options exist, achieving complete symptom control and disease management can still be challenging.

Insulin Inertia Among People With Type 2 Diabetes Mellitus in Qatar: The INERT-Q Study.

Background: Achieving and maintaining adequate glycaemic control is critical to reduce diabetes-related complications. Therapeutic inertia is one of the leading causes of suboptimal glycaemic control.

Aim: To assess the degree of inertia in insulin initiation and intensification in people with Type 2 diabetes mellitus (DM-2).

Hypergonadotropic hypogonadism and chromosomal aberrations: clinical heterogeneity and implications on the health of elderly men, case series.

Background: Hypogonadism in older men is often considered as late onset hypogonadism. However, this clinical condition results from primary testicular failure which could be of genetic origin with Klinefelter syndrome being the most common chromosomal abnormality associated with it.

Case Presentation: We report a heterogeneous group of cases who were diagnosed with hypergonadotropic hypogonadism in their adulthood and were found to have rare chromosomal aberrations.

Bimodal distribution of thyroid dysfunction triggered by COVID-19 Infection: An experience from a single endocrine center-a case series and literature review.

Background: COVID-19 infection has been spreading across the globe since the end of 2019, and it continues to cause chronic multi-system sequelae, of which thyroid dysfunction appears to be the major one. We have discussed here 10 cases of thyroid dysfunction after COVID-19 infection.

Methods: Case series report.

Management of Diabetes and Hypertension within the Gulf Region: Updates on Treatment Practices and Therapies.

Cardiovascular disease (CVD) is a leading cause of death globally, driven by the high rates of risk factors, such as diabetes and hypertension. As the prevalence of these risk factors is particularly high in the Gulf region, better diagnosis and management of type 2 diabetes (T2D) and hypertension has the potential to dramatically reduce adverse cardiovascular outcomes for individuals in that part of the world. This article provides a summary of presentations made during the EVIDENT summit, a virtual symposium on Evidence in Diabetes and Hypertension, held in September 2021, including a review of the various guidelines for both T2D and hypertension, as well as recent findings relevant to the safety and efficacy for therapies relating to these conditions.

Prevalence and risk factors for diabetic peripheral neuropathy, neuropathic pain and foot ulceration in the Arabian Gulf region.

Aims/introduction: This study determined the prevalence and risk factors for diabetic peripheral neuropathy (DPN), painful DPN and diabetic foot ulceration (DFU) in patients with type 2 diabetes in secondary healthcare in Qatar, Kuwait and the Kingdom of Saudi Arabia.

Materials And Methods: Adults aged 18-85 years with type 2 diabetes were randomly enrolled from secondary healthcare, and underwent clinical and metabolic assessment. DPN was evaluated using vibration perception threshold and neuropathic symptoms and painful Diabetic Peripheral Neuropathy was evaluated using the Douleur Neuropathique 4 questionnaire.

Safety and Effectiveness of Insulin Glargine 300 U/mL in Participants with Type 2 Diabetes Who Fast During Ramadan in The Gulf Region: A Subgroup Analysis of the Real-World ORION Study.

Introduction: To evaluate the safety and effectiveness of insulin glargine 300 U/mL (Gla-300) in people with type 2 diabetes mellitus (T2DM) in the Gulf region who fast during Ramadan.

Methods: ORION was a real-world, prospective, observational study in people with T2DM treated with Gla-300 during pre-Ramadan, Ramadan, and post-Ramadan periods. This subgroup analysis included 222 participants from the Gulf region (Kuwait, Saudi Arabia, United Arab Emirates, and Qatar).

Diabetes and Ramadan: Practical guidelines 2021.

Fasting during Ramadan is one of the five pillars of Islam and is obligatory for all healthy Muslims from the age of puberty. Though individuals with some illness and serious medical conditions, including some people with diabetes, can be exempted from fasting, many will fast anyway. It is of paramount importance that people with diabetes that fast are given the appropriate guidance and receive proper care.

Successful use of the sodium-glucose co-transporter-2 inhibitor dapagliflozin in patients with renal transplant and diabetes: a case series and literature review.

Unlabelled: Management of patients with diabetes and renal transplant could be challenging. Transplant patients use multiple immune suppressants that can worsen or even trigger hyperglycemia. There are no data about the use of the new class of sodium-glucose co-transporter-2 (SGLT-2) inhibitor dapagliflozin in patients with renal transplant and diabetes.

A tale of many tumors and one endocrine site: A case series of pituitary metastases.

Background: Metastases to the pituitary gland are extremely rare with an incidence rate reported from an autopsy series of 1.8%-12%, and only 20% was diagnosed clinically. Tumors that commonly metastasize are breast and lung tumors.

Optimal glycaemic and blood pressure but not lipid targets are related to a lower prevalence of diabetic microvascular complications.

Background: Diabetic microvascular complications are a major cause of morbidity and are related to glycaemic control and cardiovascular risk factors.

Aims: We sought to determine the association of microvascular complications in relation to control of glycemia, blood pressure and lipids in T2DM patients attending secondary care in Qatar.

Methods: This is a cross-sectional study undertaken in patients with T2DM attending Qatar's National Diabetes Centres.

Mitigation of hypoglycemia during Ramadan using the flash glucose monitoring system following dose adjustment of insulin and sulphonylurea in patients taking multiple glucose-lowering therapies (The PROFAST-IT Study).

Background And Hypothesis: Patients with type-2 diabetes mellitus (T2DM) on multiple glucose-lowering therapies who fast during Ramadan are at increased risk of hypoglycemia. We have assessed the utility of the flash glucose monitoring system after adjusting the dose of insulin and sulphonylureas to mitigate the risk of hypoglycemia in patients with T2DM who fast during Ramadan.

Patients And Methods: Patients with T2DM on either basal insulin or a sulphonylurea and at least 2 other glucose-lowering agents received structured education and adjustment of insulin or sulphonylurea dose according to the PROFAST Ramadan protocol.

Artificial Intelligence (AI) based machine learning models predict glucose variability and hypoglycaemia risk in patients with type 2 diabetes on a multiple drug regimen who fast during ramadan (The PROFAST - IT Ramadan study).

Objective: To develop a machine-based algorithm from clinical and demographic data, physical activity and glucose variability to predict hyperglycaemic and hypoglycaemic excursions in patients with type 2 diabetes on multiple glucose lowering therapies who fast during Ramadan.

Patients And Methods: Thirteen patients (10 males and three females) with type 2 diabetes on 3 or more anti-diabetic medications were studied with a Fitbit-2 pedometer device and Freestyle Libre (Abbott Diagnostics) 2 weeks before and 2 weeks during Ramadan. Several machine learning techniques were trained to predict blood glucose levels in a regression framework utilising physical activity and contemporaneous blood glucose levels, comparing Ramadan to non-Ramadan days.

Prevalence and risk factors for diabetic neuropathy and painful diabetic neuropathy in primary and secondary healthcare in Qatar.

Aims/introduction: This study determined the prevalence and risk factors for diabetic peripheral neuropathy (DPN) and painful DPN (pDPN) in patients with type 2 diabetes in primary healthcare (PHC) and secondary healthcare (SHC) in Qatar.

Materials And Methods: This was a cross-sectional multicenter study. Adults with type 2 diabetes were randomly enrolled from four PHC centers and two diabetes centers in SHC in Qatar.

Diagnosis and management of vitamin D deficiency in the Gulf Cooperative Council (GCC) countries: an expert consensus summary statement from the GCC vitamin D advisory board.

Objective: A summary of recommendations is given within the Gulf Cooperation Council (GCC) setting on the assessment and management of vitamin D deficiency in the region.

Methods: An assembly of 11 regional experts gathered to formulate an all-inclusive approach to vitamin D deficiency within GCC.

Results And Conclusion: Several gaps were identified before regional guidelines could be developed.

Prevalence and management of diabetic neuropathy in secondary care in Qatar.

Aims: Diabetic neuropathy (DN) is a "Cinderella" complication, particularly in the Middle East. A high prevalence of undiagnosed DN and those at risk of diabetic foot ulceration (DFU) is a major concern. We have determined the prevalence of DN and its risk factors, DFU, and those at risk of DFU in patients with type 2 diabetes mellitus (T2DM) in secondary care in Qatar.

Differential effects of gender and patient background diversity on the changes in metabolic and biophysical profiles in people with type-2 diabetes from different ethnicities who fast during Ramadan (H1439); a prospective study from Qatar.

Objective: The 'PROspective Study of dose adjustment of multiple anti-diabetic therapy for Type-2 diabetic patients FASTing the Month of Ramadan aimed to assess the biophysical and metabolic effects of fasting during Ramadan, including HbA1c, weight, blood pressure and lipid profile.

Study Design Methods: We performed a prospective study of people with Type-2 diabetes who were on ≥3 drugs for lowering glucose before and after Ramadan of H1438 (May-June 2017) in Hamad Medical Corporation, Qatar. We enrolled 228 participants, of whom 181 completed the study and were included in the analysis.

Incidence of hypoglycaemia in patients with type-2 diabetes taking multiple glucose lowering therapies during Ramadan: the PROFAST Ramadan Study.

Objective: To assess the incidence of hypoglycemia in people with type-2 diabetes mellitus (T2DM) on three or more anti-diabetic medications during Ramadan.

Study Design Methods: We have studied people with T2DM on three or more glucose-lowering drugs during Ramadan of H1438 (May-June 2017). The dose of each drug was adjusted according to a pre-specified protocol.

Prevalence and risk factors for painful diabetic neuropathy in secondary healthcare in Qatar.

Aims/introduction: Painful diabetic peripheral neuropathy (PDPN) has a significant impact on the patient's quality of life. The prevalence of PDPN in the Middle East and North Africa region has been reported to be almost double that of populations in the UK. We sought to determine the prevalence of PDPN and its associated factors in type 2 diabetes mellitus patients attending secondary care in Qatar.

Metformin or insulin: logical treatment in women with gestational diabetes in the Middle East, our experience.

Objective: The debate still continues about the preferred modality of treatment of gestational diabetes requiring pharmacological treatment. Insulin was previously considered as the gold standard, but the National Institute of Health and Care Excellence now recommend metformin as the first line drug of choice. The pharmacological management of gestational diabetes mellitus in the Middle East with its high risk population has not been widely published.

A pilot study using flash continuous glucose monitoring in patients with type-2 diabetes on multiple anti-diabetic agents during Ramadan.

Background: This study aims to examine the incidence of hypoglycaemia, based on activity, during Ramadan in patients with type 2 diabetes mellitus who were on were on three or more anti-diabetic medications.

Methods: Type 2 diabetes patients who fasted during Ramadan and were on three or more anti-diabetic medications were studied for two weeks using flash glucose monitoring. The patients were asked to document all episodes of hypoglycaemia and were classified as active or sedentary according to their daytime activity.

Metformin Use Is Not Associated With B Deficiency or Neuropathy in Patients With Type 2 Diabetes Mellitus in Qatar.

Background: Metformin may lead to B deficiency and neuropathy. There are no published data on the prevalence of Metformin-related B deficiency and neuropathy in the Arabian Gulf.

Aims: Determine whether Metformin intake is associated with B deficiency and whether B deficiency is associated with diabetic peripheral neuropathy (DPN) and painful diabetic neuropathy.

Sir Henry Solomon Wellcome and Dr Andrew Balfour: an enterprise on the Nile and the early foundation of public health and medical research in the Sudan (1899-1935).

In Sudan, modern medical practice and medical research began soon after the creation of Anglo-Egyptian Sudan at the turn of the 20th century. The benevolent involvement of Sir Henry Solomon Wellcome, and the ingenious feat of his protégé Sir Andrew Balfour, was crucial to the strong foundation of that establishment. Sir Henry Wellcome provided the financial sponsorship plus influential, logistical and moral support.