Introduction: Type 1 diabetes mellitus (T1DM) is on the rise in Saudi Arabia. Management of T1DM is crucial in curbing the economic burden of this disease. Studies on insulin pump issues are scarce in the region. The present study aims to fill this gap. Methods: In this single-centre, retrospective study done in King Abdulaziz Medical City (KAMC) from March 2018 to March 2019, a total of 118 known Saudi T1DM adults (34 males and 84 females) were included. Data on demographics, glycated haemoglobin (HbA1c) and CSII use were collected. Results: The most common problem encountered by the patients on CSII was breaking down of the pump (30.0%), relocation of the cannula or tubing (22%) and air bubbles affecting delivery (16.1%). Eighty-one subjects (68.6%) claimed to have been admitted for DM management while on CSII. The use of CSII led to a significant reduction in HbA1c in all subjects (p \ 0.001), but levels remain suboptimal. Only 53 subjects (44.9%) reported no significant problems in their CSII experience. Conclusion: There is a high prevalence of T1DM adult patients experiencing device malfunctions and other issues while on CSII therapy. This may account for suboptimal improvement in the glycaemic control among T1DM Saudi patients. Issues on adherence and device malfunctions should be investigated further.

BACKGROUND: Celiac disease (CD) is an autoimmune disease that is highly associated with type 1 diabetes mellitus (T1DM). The reported prevalence of CD in patients with T1DM in Saudi Arabia varies and the number of studies is limited. OBJECTIVES: Determine the prevalence of CD diagnosed with anti-tissue transglutaminase (anti-tTG) antibodies or by endoscopic biopsy in adolescents and adults with T1DM. DESIGN: Cross-sectional, retrospective medical record review. SETTING: Tertiary care center. PATIENTS AND METHODS: The study population included adolescents and adults with T1DM who were screened for CD between 2010 and 2019. The study variables included age, sex, age at diagnosis of T1DM, age of positive celiac screening, glycated hemoglobin (HbA1c), total daily insulin dose, frequency of diabetic ketoacidosis (DKA) and other autoimmune diseases. MAIN OUTCOME MEASURES: The prevalence of celiac disease in adolescents and adults with T1DM. SAMPLE SIZE: 539 patients. RESULTS: The prevalence of positive celiac test results was 11.5% (n=62). A small proportion (n=5, 8%) of the positive CD group was diagnosed with T1DM after they tested positive with the celiac screening test. Ten (16%) were diagnosed with T1DM and CD in the same year. The rest of the sample had a positive screening test after being diagnosed with T1DM. There was no statistically significant difference between the CD positive and negative groups for HbA1C, DKA frequency, microvascular complications of diabetes or thyroid disorder. For histopathological confirmation of CD, only 37% (n=23) of the group with a positive screening test underwent endoscopy. In this group, 43% (n=10) had normal endoscopic biopsy findings, 21.7% (n=5) had partial villous atrophy and 34.7% (n=8) had total villous atrophy. CONCLUSIONS: This study highlights the importance of screening for CD in T1DM patients. CD prevalence is high in patients with T1DM, despite the high likelihood of underdiagnosis. Additional studies of different age groups and the use of different study methods are required. In addition, a unified national strategy to diagnose CD in T1DM patients is highly advisable. LIMITATIONS: Retrospective, single-center, few confirmations of CD by intestinal biopsy. CONFLICT OF INTEREST: None.

Introduction A proportionate short stature (SS) assessment involves the documentation of normal growth hormone secretion via a growth hormone (GH) stimulation test. All available GH stimulation tests have some disadvantages. The decision to initiate GH therapy is dependent on multiple factors, including the GH stimulation test result. However, many patients receive GH therapy, even if they have a normal GH stimulation test result, with the indication of a presumed idiopathic SS. Objective In this study, we investigated the use of the GH stimulation test result in initiating GH therapy. Method A cross-sectional study was conducted with patients diagnosed with proportionate SS. Age, gender, insulin-like growth factor 1 (IGF-1) level, and GH stimulation test results were collected retrospectively from the electronic medical records. The main outcome variable was the decision related to prescribing GH therapy. Results A total of 286 patient charts were reviewed, and the majority (n = 201, 64.6%) were male. For just less than half (n = 136, 47.6%), the result of the GH stimulation test was ≥ 10 ng/mL, in a small proportion (n = 53, 18.5%) the result was < 5 ng/mL, and for the rest of the cohort, the result was 5.0 - 9.9 ng/mL. The majority (n = 219, 70.4%) received GH therapy, irrespective of the GH stimulation test result. The odds ratio (OR) for GH treatment was 3.9 (CI: 1.79 - 8.49) and 3.0 (CI: 1.21 - 7.42) for patients with a result < 5 ng/mL and 5.0 - 9.9 ng/mL, respectively, compared to the group with a result of ≥ 10 ng/mL. Conclusion GH therapy is frequently prescribed for patients with SS, irrespective of the GH stimulation test result. However, the group with SS with a result of < 9.9 ng/mL was more likely to receive GH therapy. The question of whether a GH stimulation test is required, in the context of SS, is debatable.

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