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A qualitative study was carried out to explore the health status of people with diabetes during Ramadan. Fifteen patients participated in two focus group discussions. Most respondents reported lack of knowledge regarding their own conditions and do not follow the medical advice of not fasting during Ramadan. Barriers facing the patients seeking healthcare before and during Ramadan were the atmosphere, long distances to facilities, monthly appointments, and monthly prescribed medication. All respondents agreed on the importance of physical activity but their opinions varied on how to conduct it. Regarding the services, most respondents were unsatisfied due to the lack of health services provided in addition to the shortage of essential medication or laboratory investigations. Others blamed primary healthcare-center staff for the delay in laboratory investigation results and the unavailability of glycosylated hemoglobin (HbA1c). Respondents also claimed that self-check glucometer measurements are not as accurate as laboratory results. Doctors may be able to educate patients regarding the effects of fasting with diabetes whereas religious leaders may influence individuals to follow doctors' advice. Evaluation of the quality of healthcare services is necessary to identify defects in health services in order to ameliorate service quality, including availability of drugs and glucometers in pharmacies, and laboratory investigations, including HbA1c, to meet patient satisfaction.

Diabetes mellitus substantially increases cardiovascular disease (CVD) risk. Among Saudi Arabian citizens with diabetes, little is known about the prevalence and control of other CVD risk factors. We extracted data from medical records of a random selection of 422 patients seen between 2008 and 2012 at two diabetic clinics in Riyadh, Saudi Arabia. We calculated the proportion of patients who had additional CVD risk factors: obesity (body mass index ⩾ 30 kg/m 2 ), hypertension (BP ⩾ 140/90 mmHg), elevated cholesterol fractions, and multiple risk factors). Further, we calculated the proportion of patients meeting the American Diabetes Association’s recommended care targets for each risk factor. Of 422 patients (mean age, 52 years), half were women, 56% were obese, 45% had hypertension, and 77% had elevated LDL concentrations. In addition to diabetes, 70% had two or more CVD risk factors. Although 9% met both target HbA1c and BP values, only 3.5% had optimum HbA1c, BP, and lipid values. In Saudi Arabia’s best diabetes clinics, most patients have poor control of their disease. This huge disease burden and related care gaps have important health and financial implications for the country.

High blood pressure (BP) is a major risk factor for cardiovascular diseases and was identified as the most significant single preventable cause of mortality. The prevalence of hypertension in Saudi Arabia is high. To raise awareness and identify undiagnosed hypertension, the Saudi Ministry of Health participated in the May Measurement Month (MMM) 2019 global screening initiative of the International Society of Hypertension. Ninety-two primary care centres across the Kingdom recruited respondents aged ≥18 years through opportunistic sampling, from 1 May to 30 August of 2019. Data collection included sociodemographic, lifestyle habits, environmental, and anthropometric indicators. Blood pressure was measured twice using automated BP devices. A total of 25 023 adults were screened with a mean age of 42.4 (16.7) years and a mean body mass index of 27.5 (6.0) kg/m2. In total, 43.6% of participants were females and 56.4% were males. Of all the participants with hypertension, 60.8% were aware, 60.8% were on antihypertensive medication, and 39.3% had controlled BP (systolic BP <140 mmHg and diastolic BP <90 mmHg). Moreover, out of 4440 participants on antihypertensive medication, only 64.6% had controlled BP. The high numbers of individuals with hypertension and with undiagnosed hypertension highlight the importance of BP screening campaigns to increase awareness, detection, and target treatment on a national level. Findings from this study can form a baseline by which to measure progress in future iterations of MMM.

The Middle‐East and Africa Influenza Surveillance Network ( MENA ‐ ISN ), established in 2014, includes 15 countries at present. Country representatives presented their influenza surveillance programmes, vaccine coverage and influenza control actions achieved, and provided a list of country surveillance/control objectives for the upcoming 3 years. This report details the current situation of influenza surveillance and action plans to move forward in MENA ‐ ISN countries. Data were presented at the 8th MENA ‐ ISN meeting, organized by the Mérieux Foundation that was held on 10‐11 April 2018 in Cairo, Egypt. The meeting included MENA ‐ ISN representatives from 12 countries (Algeria, Egypt, Jordan, Kenya, Lebanon, Libya, Morocco, Pakistan, Saudi Arabia, South Africa, Tunisia and United Arab Emirates) and experts from the Canadian Centre for Vaccinology, and the World Health Organization. Meeting participants concluded that influenza remains a significant threat especially in high‐risk groups (children under‐5, elderly, pregnant women and immunosuppressed individuals) in the MENA ‐ ISN region. Additional funding and planning are required by member countries to contain this threat. Future meetings will need to focus on creative and innovative ways to inform policy and initiatives for vaccination, surveillance and management of influenza‐related morbidity and mortality especially among the most vulnerable groups of the population.

Introduction: The alarming increase in type 2 diabetes mellitus (T2DM) in Saudi Arabia is aggravated by increasing obesity, sedentary lifestyle, and population aging. The RIMODIS study aimed at describing the practices in the therapeutic management of patients with T2DM treated with different insulin regimens. Methods: This national, multicenter, non-interventional, cross-sectional disease registry on the real-life therapeutic management of insulintreated patients with T2DM in Saudi Arabia enrolled 3010 patients. It primarily aimed at describing treatment patterns, complications, and glycemia levels. Patients completed the diabetes treatment satisfaction questionnaire (DTSQ). Data on different treatment patterns were analyzed using chi-square or Fisher's exact test. Outcomes were analyzed according to the different insulin regimen subgroups (basal versus premixed).Results: Over 60% of patients were treated with premixed insulin and most patients were also prescribed oral antidiabetics (OADs). Patients on insulin alone seemed to achieve better glycated hemoglobin (HbA1c) control. Adding OADs to insulin slightly increased treatment satisfaction scores, with scores higher in patients on basal insulin compared to premixed insulin. Hypoglycemia was lower when adding OADs to insulin. Most patients showed high treatment adherence; however, two-thirds of study patients failed to achieve glycemic target levels. Conclusion:Most patients are treated with a combination of insulin and OADs, associated with glycemic control and low incidence of hypoglycemia. However, we highlight suboptimal glycemic target achievement, underscoring the need to improve T2DM clinical management and promote healthier lifestyle among patients in Saudi Arabia.

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Introduction Noncommunicable diseases are one of the main challenges that affect health worldwide and have been found to be increasing in both low- and middle-income countries compared with high-income countries. The aim of this study was to assess the impact of financial incentives and a comprehensive care program focusing on patients' behavior and self-management of uncontrolled type 2 diabetes (glycosylated hemoglobin [HbA1c] ≥ 7), as well as modifiable risk factors for disease complications in a Saudi Arabian population. Methods This quasiexperimental study, using a pre- and postevaluation approach, was used to compare the level of HbA1c among patients with uncontrolled diabetes before and after the financial incentives and comprehensive care program were implemented. Financial awards were given to patients who achieved a significantly greater decrease in HbA1c levels with his/her responsible physician. The study population included 702 Saudi Arabian patients with type 2 diabetes from 14 regions and 34 primary healthcare centers in the Kingdom of Saudi Arabia. All of these patients (≥ 15 years old) with uncontrolled type 2 diabetes who attended local primary healthcare centers in Saudi Arabia for a follow-up visit from February to October 2018. Results The mean age, in years, of the sample was 56.14 (± SD = 9.909); slightly more than half of the patients 401 (57.1%) were females. Most of the participants 645 (91.9%) were married, and 381(54.3%) patients were housewives. Linear mixed modeling revealed that all groups showed improvements over time in the primary outcome of HbA1c levels (p = 0.009), Including the secondary outcomes of body mass index and systolic and diastolic blood pressure (p = 0.04, < 0.001, 0.019 respectively). Conclusions Patient behavior was improved, which was reflected by decreases in HbA1c, body mass index, and blood pressure levels. A comprehensive care program is recommended by healthcare providers to increase awareness among patients with diabetes to reduce other risk factors. These kinds of interventions positively motivate patients with diabetes to control their health measurements and to adopt a healthy lifestyle.