Attendees of 15 health centers in Urban and rural areas in the Riyadh region were screened for obesity during May and June 1994. Systemic selection yielded 1580 Saudi males for analysis. The mean age was 33.6 ± 13.5 years and body mass index (BMI) was 26.9 ± 5.7 kg/m 2 . Only 36.6% of subjects were their ideal weight (BMI < 25 kg/m 2 ), while 34.8% were overweight (BMI 25-29.9 kg/m 2 ), 26.9% were moderately obese (BMI 3.0-40 kg/m 2 ) and 1.7% were morbidly obese (BMI > 40 kg/m 2 ). Middle age, lower education and joblessness predicted a higher risk for obesity. Patients living in rural areas had greater BMIs than those living in urban areas (P < 0.01). Forty percent of overweight participants did not think they were so. The high prevalence of obesity and the lack of awareness among those afflicted emphasizes the need for community-based programs for preventing and reducing obesity, since weight control is effective in ameliorating most of the disorders associated with obesity, such as Type II non-insulindependent diabetes mellitus, hypertension, stroke, heart disease, sleep apnea syndrome and osteoarthritis of the knees. Young parents who are at risk of developing obesity and who play a central role in perpetuating it in their offspring should be the target of obesity-prevention programs. Ann Saudi Med 1996; 16(3):269-273. Obesity is a common chronic disorder in affluent societies, with serious effects on health and longevity.1 It is associated with the increased frequency of a number of diseases, such as hypertension, diabetes mellitus, elevated serum cholesterol, arthrosis, gout and gallbladder disease.2 These co-morbidities contribute to the excess mortality observed among the obese. In addition, obesity plays a direct role in the development of coronary artery disease. 3Over the past two decades, Saudi Arabia has undergone remarkable and rapid economic development. 4 This has brought with it some of the diseases associated with affluence, of which obesity is one of the most obvious and important in view of the manner in which it increases the risk for morbidity and mortality.A small retrospective study has shown obesity to be prevalent in Saudis living in the Eastern province. 5 Few other studies have addressed this issue in Saudi Arabia and neighboring Arab Gulf countries. [6][7][8][9][10][11] We have previously reported on the high prevalence of clinically significant obesity among Saudi females, 12 but there are no studies of obesity and its associated risk factors among males in central Saudi Arabia. The present study was designed to determine the prevalence of obesity and its associated risk factors among Saudi men attending primary health care centers in Riyadh. MethodsA cross-sectional study was undertaken which included urban and rural health centers in the Riyadh region. Eleven urban and four rural health centers were randomly selected. Saudi male patients attending these health centers were included.The study was conducted over two months (May and June 1994). Systematic sampling was used to select...

More than 50 million Muslims throughout the world with type 2 diabetes mellitus (T2DM) fast for one lunar month (Ramadan) each year. Health care providers within and outside the Muslim world need to be aware of the nature of these partial days of fasting and their risks (and potential benefits) to people with T2DM, and need to provide Ramadan-adjusted diabetes care. Hypoglycemia during the fasting days represents the greatest health risk for these patients; hence, diabetes-related pharmacotherapy needs to be tailored and adjusted with this risk in mind. With limited trial data available, this review proposes practical modifications to the usual pre-Ramadan antidiabetic regimens that are based on pathophysiological principles, clinical trial evidence (where available), expert opinion, and extended practical experience. Individualization of care is paramount in this regard to take into consideration the patient and societal, cultural, and economic variables.

Aims: Developing countries face a high and growing burden of type 2 diabetes. We surveyed physicians in a diverse range of countries in the Middle East and Africa (Egypt, Kingdom of Saudi Arabia, United Arab Emirates, South Africa and Lebanon) with regard to their perceptions of barriers to type 2 diabetes care identified as potentially important in the literature and by the authors. Methods: One thousand and eighty-two physicians completed a questionnaire developed by the authors. Results: Most physicians enroled in the study employed guideline-driven care; 80-100% of physicians prescribed metformin (with lifestyle intervention, where there are no contraindications) for newly diagnosed type 2 diabetes, with lifestyle intervention alone used where metformin was not prescribed. Sulfonylureas were prescribed widely, consistent with the poor economic status of many patients. About one quarter of physicians were not undertaking any form of continuing medical education, and relatively low proportions of practices had their own diabetes educators, dieticians or diabetic foot specialists. Physicians identified the deficiencies of their patients (unhealthy lifestyles, lack of education and poor diet) as the most important barriers to optimal diabetes care. Low-treatment compliance was not ranked highly. Access to physicians did not appear to be a problem, as most patients were seen multiple times per year. Conclusions: Physicians in the Middle East and South Africa identified limitations relating to their patients as the main barrier to delivering care for diabetes, without giving high priority to issues relating to processes of care delivery. Further study would be needed to ascertain whether these findings reflect an unduly physician-centred view of their practice. More effective provision of services relating to the prevention of complications and improved lifestyles may be needed. What's knownIt is known that the success of care for diabetes depends critically on the delivery of optimised care for diabetic patients. Many barriers to the delivery of such care have been identified. Relatively little is known regarding how these barriers influence the delivery of diabetes care in the Middle East and South Africa. What's newPhysicians generally followed management guidelines in type 2 diabetes care. Perceived barriers to optimal diabetes care mainly focussed on attributes of patients, rather than process issues in care or aspects of the physicians' practice.

Important barriers to the delivery of optimal diabetes care exist in the Middle East and Africa.

A study of 1005 family practice attenders at King Fahad National Guard Hospital was conducted during February 1993 to determine the prevalence of hyperlipidaemia and its association with participants' sociodemographic characteristics and clinical problems. The percentage of patients with total serum cholesterol concentration (TSCC) of 5.2-6.8 mmol/l was 39.3%, while those with TSCC exceeding 6.8 mmol/l was 9.5%. Hypertriglyceridaemia (TG > 2.5 mmol/l) was found in 5%. TSCC increased progressively with age up to the seventh decade. TSCC was higher among obese and diabetic patients than others. Obesity body mass index (BMI) > 29.9 kg/m2 was found in 32.8%, diabetes mellitus in 24.2%, hypertension in 11.1% and both diabetes and hypertension in 6.4%. There is an urgent need to equip primary health care teams with training and resources to help them give proper dietary advice, modify the local lifestyle and screen at least high-risk groups for hyperlipidaemia and other coronary risk factors.

In the Saudi Arabian population, serum HCYS is not a risk factor for CHD, but is lower in patients with DM.

To determine the pattern of hospitalization of patients with diabetes mellitus (DM), the computer stored data on admission with DM as the primary or secondary diagnosis to King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia over six years (1986 to 1991) were analyzed. There were 3037 admissions of 2299 patients with diabetes mellitus (2.6% of all hospital admissions), occupying 33,253 hospital bed days (3.5% of all hospitalization days). Twenty-four percent of admissions were recurrent, 4% were frequent (more than once a year) and 6% were prolonged (more than four weeks). DM was the primary diagnosis in 39%, secondary to other illness in 47% and related to diabetes in pregnancy in 14%. Diabetes-related admissions contributed 54% of all hospital bed-days used by patients with DM and were for acute metabolic complications (and hence potentially avoidable) in only 10.6% of these admissions. These patients spent an average 3.26 days per year in hospital, which is double the published expected rates. Pregnancy-related admissions of females with diabetes are short in duration. When diabetes is a secondary diagnosis, the reasons for admission are mostly related to degenerative diseases similar to those in the nondiabetic population. Patients admitted to KKUH with DM are more likely to stay longer and be admitted more often than when DM is a secondary diagnosis. The majority of diabetes-related admissions are nonacute and potentially avoidable. Identification of risk factors for and prevention of lengthy recurrent admissions should be a priority in health care resource allocation.

Purpose Impact of ramadan fasting on healthy and women with diabetes is already known. However, there is a scarcity of data on impact of fasting on pregnant women with diabetes. Moreover, religious and medical recommendations advise pregnant women against fasting as it is unsafe. Despite being exempted, many pregnant Muslim women with diabetes still choose to fast during ramadan. This study investigated different glycemic marker as an indicator for diabetes control in fasting pregnant women. Patients and Methods This is a prospective observational study. A total of 89 pregnant diabetes women were recruited. Blood glucose was self-monitored in all the pregnant women using glucose monitoring device at home. We measure the fructosamine, HbA1c levels before, during and after ramadan. Results Pregnant women with type 1 diabetes were 14 (25%), type 2 diabetes were 21 (37.5%), and gestational diabetes were 21 (37.5%). The mean fructosamine level decreased during and after ramadan in gestation diabetes pregnant women compared to type 2 diabetes and type 1 diabetes pregnant women subjects (p = 0.009). Conclusion The present study indicates that pregnant women with diabetes were able to fast during ramadan and there fructosamine level reduced during fasting. Utilization of fructosamine for short-term monitoring of glycemic control in addition to home glucose monitoring in pregnant women with diabetes will provide a good index of glycemic control. Recommendation Religious and medical recommendations advise pregnant women against fasting as it is unsafe, and they are under high risk. However, if they insist to do fast, they must do under strict medical supervision and fructosamine can be used as a glycemic control marker.