Aim
To investigate the epidemiology and clinical management of patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease (eASCVD) or high/very high ASCVD risk, ...defined by the 2021 European Society of Cardiology Guidelines, in seven countries in the Middle East and Africa (PACT‐MEA; NCT05317845), and to assess physicians' attitudes and the basis for their decision‐making in the management of these patients.
Materials and Methods
PACT‐MEA is a cross‐sectional, observational study undertaken in Bahrain, Egypt, Jordan, Kuwait, Qatar, South Africa and the United Arab Emirates based on a medical chart review of approximately 3700 patients with T2D in primary and secondary care settings, and a survey of approximately 400 physicians treating patients with T2D.
Results
The primary and secondary objectives are to determine the prevalence of eASCVD and high/very high ASCVD risk in patients with T2D. Current treatment with cardioprotective antidiabetic medication, the proportion of patients meeting the treatment criteria for reimbursement in the study countries where there is an applicable reimbursement guideline, and physician‐reported factors in clinical decision‐making in T2D management, will also be assessed.
Conclusions
This large cross‐sectional study will establish the estimated prevalence and management of eASCVD and high/very high ASCVD risk in patients with type 2 diabetes across the Middle East and Africa.
Background Male obesity is one of the most associated factors with substandard testosterone levels. However, there is growing evidence linking low testosterone levels to insulin resistance and ...diabetic complications. We aimed to study the impact of diabetes mellitus on testosterone levels and to assess the correlation of various clinical and biochemical factors with hypogonadism. Subjects and methods This case-control study was conducted on 160 adult males categorized into four equal groups (40 each); Group A: lean men with T2DM, Group B: obese with T2DM, Group C: lean with normal glycemic profile, Group D: obese with normal glycemic profile. Serum total testosterone (TT), SHBG and HbA1c have been measured. Free testosterone (cFT) and HOMA-IR were calculated. Results A significant negative correlation of serum TT and cFTwith BMI (r -0.16, p 0.04/ r -0.26, p < 0.001, respectively) and with waist circumference (WC) (r -0.23, p 0.003 and r -0.3, p < 0.001, respectively). A significant decrease in TT and cFT in the diabetes group versus the non-diabetes one (p < 0.001 for both). TT level was significantly lower in the diabetic lean group than in the non-diabetic lean (p < 0.001), and even significantly lower than in the non-diabetic obese (p < 0.001). TT level in the diabetic obese group was lower than in the non-diabetic obese (p < 0.001). The same for cFT level, lower in the diabetic lean group than in non-diabetic lean (p < 0.001) and lower in the diabetic obese than in the non-diabetic obese (p < 0.001). Concomitant significant reduction in SHBG in the diabetes group (p < 0.001). Linear regression analysis revealed that TT significantly correlated with HOMA-IR. HOMA-IR with WC, age and the duration of diabetes correlated significantly with cFT. In our model, HOMA-IR and HbA1c accounted for approximately 51.3% of TT variability (adjusted R-squared 0.513). Conclusions The impact of T2DM on serum testosterone levels was more significant than that of obesity. Our study showed a decrease in SHBG together with cFT among the diabetes group. Hypogonadism is significantly correlated to insulin resistance and poor glycemic control, which implies another perspective on the impact of suboptimal glycemic control on the development of hypogonadism. Keywords: Testosterone, Lean, Obese, T2DM
The International Diabetes Management Practices Study (IDMPS) is an international annual survey aiming to study and characterize the current standards of care for managing DM in developing countries.
...In Egypt, DM represents a substantial burden on the healthcare system, with an estimated 10.9 million patients, ranking it 10th amongst countries with the highest prevalence of DM. Previous studies showed that to maintain safety and achieve treatment goals among diabetic patients, optimal insulin therapy should be selected individually based on the patient's needs. We reported the proportion of Egyptian T2DM patients on insulin therapy who participated in the eighth wave of the IDMPS.
The 2018 IDMPS wave consisted of cross-sectional and longitudinal phases and aimed to evaluate the proportion of T2DM who were on insulin therapy in 13 countries from four regions. In Egypt, 17 physicians agreed to participate in the present study and were required to include at least one patient.
A total of 180 T2DM patients were included in the cross-section phase. At the end of the ninth month of follow-up, data from 170 T2DM patients were available. A total of 39 T2DM patients (21.7%) were on insulin therapy, with a mean duration of 32.4 ± 36.6 months. More than half of the patients (n = 22; 56.4%) were on basal insulin, mainly long-acting (n = 20; 90.9%). The mean basal insulin daily dose was 0.3 ± 0.1 IU/Kg. Notably, 28.2% of the patients received insulin via vials, and 46.2% stated that they were adjusting the insulin dose by themselves. On the other hand, 60.2% of the study population was on oral antidiabetic drugs at the cross-sectional phase. Nearly 17.4% and 27% of the patients in the cross-sectional phase achieved the glycemic target per recommendations of international guidelines and the treating physicians, respectively. At the end of the longitudinal phase, the percentage of T2DM patients who achieved glycemic targets increased to 38.4% and 77.4% as per recommendations of international guidelines and the treating physicians, respectively. Overall, 38.3% of T2DM patients received diabetes education, and 28.9% were involved in an educational program provided by the physician or their clinical staff. Besides, 85.5% of T2DM patients followed their diabetes medication dosage and frequency strictly as prescribed.
The proportion of insulin use in patients with T2DM aligned with the previous studies from different countries; however, it is still inadequate to achieve the targeted glycemic control. Nearly one-third of Egyptian patients received diabetes education, highlighting the need for adopting a national educational program. Nonetheless, the level of adherence among T2DM from Egypt appears to be high.
•The age adjusted prevalence of T2DM in Alexandria, Egypt is 16.7%.•The burden is higher among women (19.1% vs. men 12.7%).•Prediabetes represents another hidden burden with a prevalence of ...14.6%.•Abdominal obesity is an independent associated factor for T2DM in Egyptians.
To determine the prevalence of type 2 diabetes mellitus in a sample of the adult population of Alexandria, Egypt, and to delineate the epidemiologic profile of the disease in this community.
This cross-sectional study was conducted on a representative sample of the population. Participants provided demographic data, their medical history, and blood samples for measurement of plasma glucose (fasting and after oral glucose load) and underwent a detailed physical examination.
Of 10,640 eligible subjects, 9657 (90.8%) aged 18–90 years agreed to participate (3795 men, 5862 women). We found an age-adjusted prevalence of diabetes of 16.8% (men, 12.7%; women 19.1%); of prediabetes, 14.6% (men, 13.5%; women, 15.2%), and of newly diagnosed diabetes, 5.5% (men, 3.3%; women, 6.6%). Diabetes was most common in people older than 50 years; prediabetes was most common in 30–39-year-old men and in women younger than 20. In logistic regression analysis, factors independently associated with prediabetes were a history of dyslipidaemia, urban residence, and widowhood. Independent associated factors for diabetes were a high waist-to-hip ratio, family history of diabetes, being divorced, history of dyslipidaemia, peripheral arterial disease or hypertension, low education level, and being not working.
We found a high prevalence of diabetes and prediabetes in Alexandria, particularly in the middle-aged population. Given globally increasing life expectancies, the number of individuals with diabetes could become particularly challenging to the Egyptian healthcare system. Comprehensive national preventive measures are urgently needed.
Background
Many patients with type 2 diabetes (T2DM) suffer from diabetic peripheral neuropathy (DPN) and impaired muscle coordination. These changes may lead to walking instability, and gait ...abnormalities resulting in increased fall risk and lower limb amputations. The aim of this study was to assess the impact of DPN and patient footwear on the gait in patients with diabetes, in addition to Comparing the peak plantar pressure (PPP) in patients with and without DPN and assessing its association with gait abnormalities.
Methodology
This is an observational case–control study. Forty Subjects with T2DM were divided into two age and sex-matched groups, 20 subjects each. Group A: subjects with DPN. Group B: subjects without DPN. All study participants were subjected to a thorough history taking, clinical examinations focusing on detailed foot examination, PPP assessment, and functional gait evaluation.
Results
The results obtained in this study showed a median gait assessment score of 21 (17.0–22.5) for group A and 26 (23.5–26.0) for group B which was statistically significant (
p
< 0.001). There was no statistically significant difference between both groups (
p
> 0.05) regarding the assessment of footwear appropriateness. Comparing the PPP measurement among both studied groups, the prevalence of an elevated PPP was 80% in group A compared to 65% in group B, which was statistically non-significant,
p
= 0.288.
Conclusions
Gait abnormalities are common among patients with T2DM even in the absence of DPN. However, the presence of DPN was the strongest independent risk factor for gait abnormalities among the studied factors.
This non-interventional observational study aimed to describe the clinical outcomes of patients with T2DM treated with Gla-300 during the period of Ramadan.
Type 2 diabetes mellitus (T2DM) patients ...who decide to fast during the holy month of Ramadan face several challenges in achieving glycemic control without increasing the risk of hypoglycemia. Insulin glargine-300 (Gla-300) has well-established safety and efficacy in improving glycemic control in multiple randomized clinical trials (RCTs). However, limited evidence is available regarding its safety and effectiveness during fasting.
The objective of this study was to assess the safety and clinical outcomes of insulin glargine-300 (Gla-300) in T2DM patients before, during, and after Ramadan.
We conducted a prospective, observational, non-comparative, multicenter study on patients with T2DM currently treated with Gla-300 who planned to fast and continue on Gla-300 during Ramadan in four countries (Egypt, Jordan, Lebanon, and Turkey). The study outcomes included the change in glycemic parameters and incidence of hypoglycemia before, during, and after Ramadan.
One hundred and forty T2DM patients were included. Nearly 61% of the included patients had a duration of diabetes of <10 years. The mean Gla-300 daily doses during the pre-Ramadan, Ramadan, and post-Ramadan periods were 22.2 ±7.4, 20.4 ±7.5, and 22.5 ±4.7 IU, respectively. The mean change values from pre-Ramadan to Ramadan and post-Ramadan were -1.7 ±6.9 IU and 0.5 ±4.7 IU, respectively, among the included patients. The mean HbA1c decreased during the study period initiating from 7.9% ±1.4% pre-Ramadan to 6.9% ±0.4% post-Ramadan. The overall HBA1c target value was 6.9% ±0.4%, while the HbA1c target was achieved by 29 patients (21.9%). The mean fasting blood glucose (FPG) showed a reduction from baseline value in the post-Ramadan period by -0.9 ±2.3 mmol/L. Five patients (3.57%) had symptomatic documented hypoglycemia during Ramadan, and none was considered to have severe hypoglycemia.
Our study showed that insulin Gla-300 maintained the glycemic control of T2DM patients who decided to fast during the holy month of Ramadan without increasing the risk of hypoglycemia. Regular self-monitoring of blood glucose levels during Ramadan is highly recommended to avoid possible complications.
To describe the characteristics and fasting experience of a subgroup of patients in the VISION study who initiated insulin therapy and chose to fast during Ramadan, and to discuss the VISION Ramadan ...substudy data in the context of previous Ramadan studies.
The VISION study was a prospective, non-interventional, observational study of adult patients with Type 2 diabetes mellitus in 6 countries in the Western Pacific, Middle East and North Africa, receiving insulin injection therapy for the first time. In this VISION Ramadan substudy, fasting data was collected during Ramadan 2014 and 2015.
Of 1617 patients in the VISION study, data was collected for 357 patients who chose to fast during Ramadan. At baseline, mean HbA1c was 10.1%, duration of diabetes was 8.8 years, and mean BMI was 30 kg/m2. All patients with non-missing data (n = 169) received advice on fasting during Ramadan. The majority of patients fasted for the full month of Ramadan, and around one-third of patients fasted outside Ramadan.
Here we provide an update on the characteristics and Ramadan experience of patients with Type 2 diabetes mellitus who initiated insulin therapy and chose to fast during Ramadan. There is still a need to explore patient’s experience during fasting, and identify and address methods to better help manage those patients.
Objectives: Contemporary data on cardiovascular (CV) burden in women with type 2 diabetes (T2D) is lacking, particularly in the Middle East and Africa where the incidence and prevalence of T2D is one ...of the highest globally. We report prevalence of ASCVD/ASCVD risk stratified by gender to identify opportunities for improving T2D care.
Methods: PACT-MEA (PACT-MEA; NCT05317845) is a cross-sectional, observational study of adults (≥18 years) with T2D from 55 clinics in Bahrain, Egypt, Jordan, Kuwait, Qatar, South Africa, and United Arab Emirates. Medical history, demographics, clinical information, and laboratory values were collected from medical charts of patients at a clinic visit in 2022. We report the prevalence (95% CI) of established atherosclerotic cardiovascular disease (eASCVD) and ASCVD risk, the latter defined by the 2021 European Society of Cardiology (ESC) Guidelines on CV Disease Prevention in Clinical Practice (risk categories: moderate, high, very high including eASCVD). Prevalence estimates were weighted according to the size of the diabetes population in each country.
Results: Of the 3,726 patients enrolled, 47% were female, with a median age of 59.0; 35% were <55 years old. Across the seven PACT-MEA countries, prevalence of eASCVD was 16.0% (95% CI: 13.4-18.6) among females and 26.6% (23.7-29.5) among males. Per ESC guidelines, 0.6% (0.0-1.2) of females were at moderate risk for ASCVD, 72.5% (69.0-75.9) were at high risk, and 26.9% (23.5-30.3) were at very high risk. Among males, 0.7% (0.0-1.5), 65.9% (62.4-69.4), and 33.4% (29.9-36.8) were at moderate, high, and very high ASCVD risk, respectively.
Conclusions: We found 1 in 6 women with T2D in the Middle East and Africa have eASCVD and nearly all are at high/very high ASCVD risk. This highlights the need for better screening and timely management of T2D in women and men to minimize CV risk, as well as the importance of gender inclusiveness in clinical studies.
Disclosure
F. Alawadi: Research Support; Novo Nordisk. E. Mashaki ceyhan: None. H. M. Sabbour: Research Support; Novo Nordisk. S. Salek: None. G. Yadav: Employee; Novo Nordisk. S. Verma: Advisory Panel; Amgen Canada, AstraZeneca, Bayer Inc., Boehringer Ingelheim and Eli Lilly Alliance, HLS Therapeutics Inc., Janssen Pharmaceuticals, Inc., Novartis Canada, Novartis, Novo Nordisk, Novo Nordisk Canada Inc., Consultant; AstraZeneca, Other Relationship; Amarin Corporation, AstraZeneca, Bayer Inc., Boehringer Ingelheim and Eli Lilly Alliance, Boehringer Ingelheim International GmbH, Canadian Medical and Surgical Knowledge Translation Research Group, EOCI Pharmacomm, HLS Therapeutics Inc., Janssen Pharmaceuticals, Inc., Novartis Canada, Novo Nordisk, Novo Nordisk Canada Inc., Pfizer Inc., PhaseBio Pharmaceuticals, Inc., S & L Solutions Event Management Inc, Sanofi, Sun Pharmaceutical Industries Ltd., Toronto Knowledge Translation Working Group, Research Support; Amarin Corporation, Amgen Canada, AstraZeneca, Bayer Inc., Boehringer Ingelheim International GmbH, HLS Therapeutics Inc., Novartis, Novo Nordisk, Pfizer Inc., PhaseBio Pharmaceuticals, Inc. S. H. Assaad-khalil: Board Member; AstraZeneca, Merck & Co., Inc., Servier Laboratories, Sanofi, Consultant; AstraZeneca, Servier Laboratories, Sanofi, Merck & Co., Inc., Research Support; Novo Nordisk, Eva Pharma. W. Almahmeed: None. N. Alamuddin: Consultant; Novo Nordisk, Speaker's Bureau; Novo Nordisk. H. Alkandari: None. J. A. Haddad: None. L. N. Husemoen: Employee; Novo Nordisk A/S, Stock/Shareholder; Novo Nordisk A/S. L. Lombard: None. R. A. Malik: None.
