Glycemic and lipids control in patients with diabetes and cardiovascular or renal diseases across all the government health sectors in the Emirate of Dubai, United Arab Emirates

Rashid, Fouzia; Abdelgadir, Elamin; Alsaeed, Maryam; Alemadi, Budoor; Khalifa, A.; Farooqi, Muhammad Hamed; Alawadi, Fatheya; Bashier, Alaaeldin

doi:10.1016/j.dsx.2018.11.013

Cited by 3 publications

(4 citation statements)

References 20 publications

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“…The prevalence of smoking is also high and rising [39]; in 2010-2011, the BREATHE study reported a 31% prevalence of cigarette and water pipe use in North Africa and the Middle East, with a high of 54% in Lebanon [40]. In addition, poor control of dyslipidaemia has been documented in Lebanon and Jordan [41,42], Pakistan (second National Diabetes Survey of Pakistan) [43] and Dubai [44], and low levels of glycaemic control have been reported in Lebanon (IDMPS study [45]) and Dubai [45]. These findings may reflect, in part, suboptimal management of CV risk factors and use of guideline recommendations [45][46][47].…”

Section: Management Of Patients With T2d In the Middle East-gulf Regionmentioning

confidence: 99%

“…However, in our clinical experience, implementation of this cardiocentric approach to the management of T2D generally remains poor in the Gulf and Levant region, with many physicians (and patients) remaining focussed on a glucocentric approach. Although we are aware that there have been recent improvements in identifying and treating CV risk factors in the region [44], primary care physicians in particular need encouragement to apply current guideline recommendations [47, 58]. There is also a need for increased community awareness of CV risk factors, and education about the importance and effectiveness of early diagnosis and treatment of these risk factors to reduce the incidence of CV events.…”

Section: Rewind: Implications For Practice Guidelinesmentioning

confidence: 99%

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From Clinical Trial Evidence to Clinical Guidelines: Perspectives on REWIND from Clinicians in the Gulf and Levant Region

Ashour,

Azar,

Echtay

et al. 2023

Dubai Diabetes Endocrinol J

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Background: Current guidelines recommend that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with proven cardiovascular benefit should be considered for first-line therapy in patients with type 2 diabetes (T2D) who have/are at high risk of atherosclerotic cardiovascular disease (CVD). Summary: Only one GLP-1 RA – dulaglutide – has demonstrated superiority versus placebo in reducing cardiovascular risk in patients with T2D with or without a history of CVD in a cardiovascular outcomes trial (CVOT). This trial – REWIND – is the only GLP-1 RA-based CVOT that recruited patients with a CVD prevalence (31%) that is similar to the estimated prevalence in primary care T2D populations in the Gulf and Levant region. In contrast, baseline CVD prevalence in all other GLP-1 RA-based CVOTs ranged from 73 to 100%. REWIND’s results provided the European Association for the Study of Diabetes and American Diabetes Association with data on which to base updated guidelines. These organisations subsequently recommended that GLP-1 RAs should be considered for primary CVD prevention in high cardiovascular-risk patients with T2D, and acknowledged that present evidence supporting GLP-1 RAs for primary prevention of CVD in T2D is strongest for dulaglutide but limited for other GLP-1 RAs. The Emirates Diabetes Society guidelines also support the use of GLP-1 RAs for primary cardiovascular prevention in patients with T2D. The cardiovascular benefit conferred by dulaglutide in patients with no CVD history, and the close alignment of the REWIND cohort with patient populations in the Gulf and Levant region, may better inform physicians in the early use of dulaglutide in patients with T2D and multiple cardiovascular-risk factors, regardless of CVD history. Utilizing published data and author opinion, this review explores the importance of taking a cardiocentric approach to T2D management, and discusses the clinical implications of REWIND for people with T2D in the Gulf and Levant region. Key Messages: Guideline recommendations, including those of the Emirates Diabetes Society, state that GLP-1 RAs with proven cardiovascular benefit should be considered for primary CVD prevention in high cardiovascular-risk patients with T2D. This recommendation was informed, in part, by REWIND; REWIND was the only CVOT to show that a GLP-1 RA (dulaglutide) reduces cardiovascular risk in patients with T2D with or without established CVD. Demonstration of cardiovascular benefit in the REWIND cohort, which aligns closely with patient populations in the Gulf and Levant region, may better inform physicians in the early use of dulaglutide in patients with T2D, regardless of CVD history.

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Section: Management Of Patients With T2d In the Middle East-gulf Regionmentioning

confidence: 99%

Section: Rewind: Implications For Practice Guidelinesmentioning

confidence: 99%

From Clinical Trial Evidence to Clinical Guidelines: Perspectives on REWIND from Clinicians in the Gulf and Levant Region

Ashour,

Azar,

Echtay

et al. 2023

Dubai Diabetes Endocrinol J

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show abstract

“…Although patients aged < 20 years represented a smaller proportion of the diabetic population, 53% of these individuals in this age group had an HbA 1c of > 9%, and only 9% had an HbA 1c of < 7% [ 18 ]. In patients with high-risk T2D, complications are common and lipid control is often suboptimal, further increasing the patient’s cardiovascular risk [ 19 ]. Data from 2012 to 2016 showed that the majority of patients who had high-risk diabetes had an HbA 1c of > 8% [ 19 ].…”

Section: Establishing Early Glycaemic Control In Patients With Diabetesmentioning

confidence: 99%

“…In patients with high-risk T2D, complications are common and lipid control is often suboptimal, further increasing the patient’s cardiovascular risk [ 19 ]. Data from 2012 to 2016 showed that the majority of patients who had high-risk diabetes had an HbA 1c of > 8% [ 19 ]. Given the chronic, progressive nature of the condition, it is imperative that high-risk patients and those of younger age receive additional support to improve their glycaemic control.…”

Section: Establishing Early Glycaemic Control In Patients With Diabetesmentioning

confidence: 99%

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

et al. 2022

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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. Of relevance to the Gulf region, the risk of hypoglycaemia with sulfonylureas during Ramadan was reviewed. For the management of T2D, sulfonylureas have been a long-standing medication used to achieve glycaemic control; however, differences have emerged between early and later generations, with recent studies suggesting improvements in the safety profiles of late-generation sulfonylureas. For patients with hypertension, incremental therapy changes are recommended to reduce the risk of cardiovascular complications that are associated with increasing blood pressure. For first-line therapy, angiotensin-converting enzyme inhibitors (ACEi), such as perindopril, have been demonstrated to reduce the risk of cardiovascular and all-cause mortality. The addition of calcium channel blockers and diuretics to ACEi has been shown to be effective in patients with poorly controlled hypertension. The different renin–angiotensin–aldosterone system inhibitors are reviewed, and the benefit of combination therapies, including amlodipine and indapamide in patients with difficult-to-control hypertension, is investigated. The benefits of lifestyle modifications for these patients are also discussed, with important clinical considerations that are expected to inform patient management in daily clinical practice.

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Progression and identification of heart disease risk factors in diabetic patients from electronic health records

Lee,

Leung,

Wong

et al. 2024

Internet of Things and Machine Learning for Type I and Type II Diabetes

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Glycemic and lipids control in patients with diabetes and cardiovascular or renal diseases across all the government health sectors in the Emirate of Dubai, United Arab Emirates

Cited by 3 publications

References 20 publications

From Clinical Trial Evidence to Clinical Guidelines: Perspectives on REWIND from Clinicians in the Gulf and Levant Region

From Clinical Trial Evidence to Clinical Guidelines: Perspectives on REWIND from Clinicians in the Gulf and Levant Region

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

Progression and identification of heart disease risk factors in diabetic patients from electronic health records

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