Dissertations / Theses on the topic 'Diabetes Saudi Arabia'

Saudi Arabia is struggling to provide quality healthcare services in light of the growing population, rapid spread of chronic diseases, and limited resources available. In addition to these obstacles, the Saudi society is a highly conservative one, and certain traditions may sometimes limit how healthcare services can be offered. This work examines the impact of a Telecare solution on the healthcare system at the National Guard Health Affairs (NGHA). It focuses on diabetes, and the challenges faced by both the healthcare officials at NGHA, and the patients. These challenges also include social factors that may pose at obstacle in delivering healthcare services. The ‘Telecare for Managing Diabetes – TeMaD’ system is designed and developed using the Soft Systems Methodology. It was then integrated into the hospital information systems at King Abdulaziz Medical City in the Central Region, and consisted of 52 participating patients, and four involved Diabetic Educators. HbA1c levels of all patients were recorded prior to commencement of the study. Patients were required to use TeMaD for a 3-month period, then, had their HbA1c levels recorded again after completion of the study. Overall observation of the results showed a reduction in the HbA1c levels of 83% of the patients. Participating patients expressed their acceptance of the system, indicating that TeMaD allowed them to overcome some obstacles such as lack of transportation. It also assisted the majority of participants to better manage their diabetes and ease communication with their diabetic educators. Most patients requested that the system be offered permanently at the clinic. Diabetic educators were in favour of integrating TeMaD into the current healthcare system at NGHA, and they were enthusiastic about its numerous benefits. Telecare solutions can be used to enhance the quality of healthcare services, meet current demands, and address obstacles faced by the healthcare system in Saudi Arabia, including social factors that are unique. They can be adopted by neighbouring Gulf States which share common obstacles in healthcare.

Diabetes has been labelled as one of the largest crises in the twenty-first century. Saudi Arabia is one of the top 10 countries for prevalence of diabetes and one in five people has the condition. Medication adherence assessment is vital to help clinicians reach therapy outcomes and identify gaps in patient management. The aim of this PhD was to explore oral hypoglycaemic medication (OHM) adherence in patients with Type 2 diabetes patients in Saudi Arabia and to identify factors associated with OHM adherence. The aim was addressed by: 1) Conducting a systematic review to identify which tools could be used to measure adherence to OHM as well as to quantify adherence levels across different countries; 2) Undertaking a cross-sectional study to quantify the prevalence of adherence to OHM in a group of patients in Saudi Arabia using a validated measure of adherence. An interview study on a subset of these patients then explored in detail Type 2 diabetic patients' beliefs and attitudes towards their OHM regimen, including factors which helped or hindered their medication taking behaviour. The systematic review included 37 studies. It showed that the level of OHM adherence varied widely across all measures: 36% to 95% when dispensing records were used, 37% to 98% with self-report, and 17% to 97% with pill counts. The term 'adherence' was most commonly used. There was no identified studies assessing OHM adherence in Saudi Arabia. The cross-sectional study showed that the level of OHM adherence was 40%, Lower adherence was associated with patients of younger age (OR, 1.084; 95% CI, 1.056-1.112), individual taking a higher number of non-OHM (OR, 0.848; 95% CI, 0.728-0.986) and having a higher HbA1c level (OR, 0.808; 95% CI, 0.691-0.943). The interview study identified several factors affecting OHM adherence using a validated theoretical framework. Facilitators of OHM adherence were OHM scheduling, knowledge about OHM, knowledge on other relevant behaviours such as diet and physical activity, knowing how to take OHM appropriately and how to manage hypoglycaemia. In addition, OHM adherence was facilitated by beliefs of preventing diabetic complications, avoiding insulin injections, achieving an improved quality of life, accepting diabetes, being optimistic about the future, and having high self-confidence. Conversely, barriers to OHM adherence were forgetfulness, cognitive overload, lack of knowledge of sexual health implications of OHM, and knowledge of OHM side effects or drug-drug interactions. Furthermore, side effects of OHM such as weight gain or hypoglycaemia, knowing how to measure blood sugar, feeling no symptoms, and having many medications to take were additional barriers to OHM adherence. The MASA study also showed that there are several social- and physical-related factors affecting OHM adherence such as the patient-physician relationship and perceived family support. The work in this PhD suggests that targeting suboptimal OHM adherence behaviour needs to be done in a comprehensive manner. The key benefit is to provide future researchers with a comprehensive range of factors that can be targeted when defining targets for an intervention(s). Further systematic intervention development and testing is required to choose and prioritise the most promising interventions to improve OHM adherence.

Most chronic non-communicable diseases result from a complex interaction between heredity and environmental factors. With better living conditions and adoption of western lifestyles in developing countries, there is an increased incidence of these diseases, the most common of which is diabetes. This study documents the prevalence of NIDDM, lOT, hypertension, obesity and hyperlipidaemia in an urban male community [n= 125] in Jeddah, Saudi Arabia. It also examines OGl'T reproducibility [n=35]; the influence of diet and physical activity; the differences in these aspects between nationals and non-nationals and the metabolic responses following the OGTT between the glucose tolerance groups [n=43]. Glucose intolerance, NIDDM [14%] and ICiT [27%], were very common. Overall, CVD risk factors such as smoking [43%], obesity [29%], hypertension [5%], hypercholesterolaemia [7%], hypertriglyceridaemia [14%], occurring in association with diabetes were high. Clustering of other risk factors such as abdominal obesity, hyperinsulinaemia and hyperproinsulinaemia were also shown. The OGTT is a poorly reproducible test in this community and a further confirmatory test is always required to establish the diagnosis of glucose intolerance. The dietary habit and food item record identified recognizable features characteristic of this community, which were affected by both the cultural and the social background. However, no differences were found between the glucose tolerance groups. Physical inactivity was a major lifestyle problem and the inactive group tended to have increased risk factors, although differences were not significant. These environmental factors could not, however, be excluded as possible causative factors in the high prevalence of glucose intolerance and CVD risk factors in this community as the sample was small. Subjects with 101' tended to have intermediate levels of risk factors and this study favours identifying IGT as an independent category which lies between normal and NIDDM. Ethnic differences should be considered whenever possible particularly in this multinational community, since 40 % of this community were non-nationals. Nationals differed in certain dietary aspects and they tended to be inactive, otherwise no other significant differences existed between the groups. As shown in different populations, those identified as ICT or NIDDM in this community, were characterised by hyperfunction of the a-cell in IGT, hypofunction of the a-cell in NIDDM and associated with immature secretion of proinsulin. The insulin resistance which was profound in NIDDM and intermediate in TOT was characterised by high glycerol and NEFA which were suggestive of insulin insensitivity at the level of adipose tissue. Large-scale and prospective studies are strongly recommended. Meanwhile, primary prevention measures are urgently required as these findings pose a significant public health problem.

Diabetes mellitus is a common chronic disease that affects approximately 382.8 million people worldwide. Globally, the Kingdom of Saudi Arabia (KSA) has the seventh highest prevalence of diabetes, with over one-fifth of the Saudi population diagnosed with diabetes. Poor understanding and low health awareness, in parallel with lifestyle choices are considered the main components behind the increase of diabetes and diabetes-related complications in KSA. There is also a lack of diabetes speciality centres, especially in remote areas of KAS. Moreover, diabetes management becomes more complicated during the Ramadan month because people observe fasting throughout the month. The month long fasting process complicates the disease status of Saudi diabetic patients with potential complications post the fasting period. In this thesis, we present the design and development of a novel and intelligent mobile diabetes management system tailored for type 2 diabetic (T2D) patients in Saudi Arabia with the focus on the integration of educational and compliance issues, which we name as the SAED system. The system was validated in two preliminary pilots in the Kingdom, one pilot being specifically dsigned to evaluate the system for diabetic patient during Ramadan fasting month. The outcomes of the clinical pilot indicated the clear effectiveness of the SAED system in lowering the HbA1c levels. The system was tested for its performance through a randomized control trial on 20 diabetic patients for a period of six months in Kingdom of Saudi Arabia. The outcomes of the pilot study showed improvements in the HbA1c levels of patients and also significant improvements in diabetes knowledge amongst the patients. The HbA1c levels of the diabetic patients in the SAED intervention group decreased from 8.76% to 7.85%. The diabetic knowledge test outcomes of the diabetic patients in the SAED intervention group significantly improved from 46.20% to 61.10%. Further, our study also tested the SAED system on diabetic patients during the Ramadan period. This is important because fasting is observed during the Ramadan month which can significantly affect the diabetes management and diagnosis amongst the patients. The study for the Ramadan period was conducted on another 20 patients using the similar approach described above. The results from the clinical trial indicated significant reductions in the number of hypoglycaemic and hyperglycaemic events during the month of Ramadan in patients who used the SAED system. The diabetes knowledge test outcomes also significantly rose from 44.60% to 64.10%. The SAED system for diabetes management using mobile technologies in KSA has been proven to be successful in improving the diagnosis and management of diabetes amongst the patients. The SAED system offers an inexpensive, practically feasible solution for diabetes self-management in KSA. Considering the social, economic, and political conditions in KSA, the SAED system can enhance the quality of healthcare provided to patients, lead to better utilization of resources, provide timely interventions, and improve the overall quality of life of diabetic patients and their family and friends.

The purpose of this study was to explore the managing of Type 2 Diabetes Mellitus (T2DM) in the Saudi healthcare system. This country was chosen for examination because it has been undergoing major demographic, social and economic changes which have caused an increase in the prevalence of chronic diseases, including diabetes. This study adopted the World Health Organization's (WHO) Innovative Care for Chronic Conditions Framework (ICCCF). This framework provided a comprehensive basis for assessing the Saudi healthcare system by addressing its components at the macro (policy), meso (healthcare organizations and community), and micro (patient and family) levels. In accordance with these three health system strata, a flexible multimethod approach was adopted by using primary and secondary data in three phases. To explore the policy environment of the Saudi health care system, the first phase involved analysing 35 national and regional T2DM documents according to four dimensions of Walt and Gilson’s health policy analysis framework: content, actors, context, and process. The second phase aimed to explore healthcare professionals’ perceptions of the barriers and facilitators of an effective healthcare organization and of community partnerships to enable T2DM management. Semi-structured interviews were conducted with 33 participants from various healthcare fields and thematic analyses were applied. The third phase aimed to assess the patients’ experiences and their interactions with healthcare providers. In this phase, the Patient Assessment of Chronic Illness Care (PACIC) survey was translated into Arabic using the WHO Steps of Translation and Adaptation of Instruments, and distributed among 575 diabetes patients in four specialized diabetes clinics. Although T2DM has highly recognised at the macro level, several challenges were identified through the documents analysis and were also highlighted during the second phase of the study. These challenges included: unreliable health information systems, a lack of multisectoral collaboration, and a lack of public awareness. At the meso level, the interview data identified three themes: the cultural determinants of T2DM, the limitations of key support systems, and recommendations for improving the support systems for T2DM patients. Within the identified themes, a number of subthemes were identified, including: physical inactivity, reliance on traditional treatments, unhealthy dietary patterns, poor primary healthcare services, lack of reliable data, shortage of qualified staff, poor guidelines dissemination, enhancing the multisectorial collaboration, and community partnerships. At the micro level, the mean score of the PACIC survey was lower in comparison to similar studies conducted internationally (mean = 2.55 out of 5). Patients scored on average 2.69 for ‘patient activation’, 3.02 for ‘delivery system/practice design’, 2.29 for ‘goal setting/tailoring’, 2.10 for ‘follow-up/coordination’, and 2.84 for ‘problem solving/contextual domain’. In addition, the reported glycaemic control measures indicated that only 17% of participants had controlled blood glucose levels (≤ 7%) which is equivalent to 8.6 mmol/L. The ICCC framework was a useful tool for exploring the main weaknesses and strengths of the Saudi healthcare system. However, it was observed that the ICCC did not significantly recognize community sensitivity, particularly community culture, religion, norms, and beliefs. Nevertheless, this study generated new knowledge about T2DM management systems in Saudi Arabia by exploring how the performance of the healthcare system is shaped by the processes occurring at the different levels; therefore. It contributes to the body of knowledge on health system research.

Saudi Arabia is a developing country faced with numerous economic, political and societal challenges. The country’s healthcare sector is in serious need of improvement due tofactors like a dilapidated transport network, suppression of women’s rights, the existence of many foreign nationals and health centers which are clustered around population centers and thus unequal to the task of providing convenient, prompt healthcare to some sections of the population. The introduction of a mobile application to manage a chronic disease such as diabetes could make it easier for patients to manage their illness and communicate with their healthcare specialists remotely; thus reducing the expense and time involved in attending appointments; as well as receiving vital information on areas such as diet, exercise and blood glucose monitoring alerts. Extensive applications in mHealth are being used globally with some success. However, Saudi Arabia has its own limitationsand is a very specific social and cultural context,and this study aims to fill the knowledge gap in the literature about how such mHealth technology would be accepted by Saudi diabetics, doctors and diabetes specialists; and a specially adapted theoretical model of technology acceptance was used. Male and female specialist doctors were interviewed and patients and doctors surveyedby means of an online questionnaire. All participants were asked to watch a short video,especially designed by the researcher to fit the Saudi context, about the functions of a diabetes management application. This primary data is a vital contribution to the understanding of the problems faced at present by Saudi diabetics in receiving adequate care and self-managing their illness, as well as providing an insight into the current state of technology acceptance for mHealth applications in Saudi Arabia. Findings reveal that both doctors and patients are generally positive about using a diabetes mHealth application but some wouldneed training, and there were concerns about privacy issues and whether its use would make more work for doctors. Culture, gender, age, education levels, income and locationwere found to impact adoption of technology in the Saudi context. The study seeks to make practical recommendations for Saudi healthcare providers and recommends starting with an IVR system based on the COSMOS Model, which addresses many of the challenges in self-management of diabetes. Furthermore, the diabetes management application ‘Glucose Buddy’ was evaluated and findings suggest that with incentives and training, this could be successfully implemented. Face-to-face communication is a major limitation in mHealth but at least patients receive care between appointments, and female patients unwilling to see male specialists can receive information and contact their hospital. The study concludes that mHealth is workable in Saudi Arabia and the model is scalable; as literacy and educational level rises, more sophisticated applications could be used. Finally, the study notes its limitations and uses them to make recommendations for further research.

Background: The Kingdom of Saudi Arabia faces one of the highest prevalence rates of type 2 diabetes mellitus (T2DM) in the world. However, there are no credible local data on the trends and future projections of the disease, and the relevant international studies underestimated the true prevalence rates. This thesis used epidemiological modelling to study the trends in T2DM prevalence in Saudi Arabia, predicted its future levels, and quantified the impact of reducing some risk factors on the disease prevalence trends. Methods: This thesis developed and validated the “Saudi IMPACT Diabetes Forecast Model”, which integrates data on the population, obesity and smoking prevalence trends in Saudis aged ≥25 years to estimate the trends in T2DM prevalence (1992-2022) using a Markov modelling approach. The model considers different reasonable scenarios of future trends in obesity prevalence, and incorporates a number of parameters to model the disease epidemiology. These parameters include the estimated diabetes incidence, case-fatality, total mortality, relative risk of diabetes if obese, and relative risk of diabetes if a smoker. The model data inputs and parameters were obtained from different sources, including local departments, medical literature and assumptions. The model results were validated against local data from the STEPwise survey in 2005, and against the model of the Global Burden of Disease study, where the model produced reasonably close results to both of these studies. Results: The prevalence of T2DM among the Saudi population aged ≥25 years was estimated to rise substantially during the 30-year period of 1992-2022 from 8.5% to 39.5%, assuming some levelling off of obesity trends (capping), or to 44.1%, assuming uncapped increasing obesity trends. In men, T2DM prevalence was estimated to increase from 8.7% to 39.2% with capped obesity trends, or to 41.3% with continuing linear increase in obesity trends. In women, T2DM prevalence was estimated to increase from 8.2% to 39.8% with capping of obesity trends, or to 47.7% without such a capping. The model showed that if the trends in obesity start to decline by 10% in 12 years (2010-2022), a relative reduction of 13% in diabetes prevalence could be achieved. If the prevalence of obesity was halted at the 2010 levels, a 10% relative reduction in diabetes prevalence could be attained by 2022. ii Conclusion: T2DM is currently a major public health challenge in Saudi Arabia, and this thesis predicted that its burden will increase substantially in the next decade. Intensive and aggressive preventive measures directed to reduce the levels of risk factors, particularly obesity and smoking, can result in reasonable reduction of the disease prevalence, and therefore should be an urgent action.

We present in this thesis the design and development of a new mobile diabetes management system for social behavioural change and management tailored for Saudi diabetic patients (SANAD - Saudi Arabia Networking for Aiding Diabetes). The hey goals of SANAD are to close the diabetes management loop by providing remote monitoring for diabetic patients, a further therapeutic channel to the patient, an opportunity to increase diabetic patients' health awareness, and feedback to help diabetic patients maintain a regular blood glucose level. The key system components consist of: (i) a smart mobile diabetes management module (MDM-M) used for collecting blodd glucose data; (ii) a social networking module (SN-M), acting as an enhancement module for the MDM-M, the key function of which is currently focused on education purposes; and (iii) a cognitive behavioral therapy module (CBT-M),a cting as a supplementary module to MDM-M. This module was designed on the smart mobile platform and used only by patients who require CBT therapeutic intervention. A usability study for the SANAD system is also presented in this thesis to validate the acceptability of using mobile technologies amongst diabetic patient in KSA and Gulf region. The preliminary results of the study indicated general acceptance of the patients in using the system with higher usability rating in type 2 diabetic patients. In general, the study concluded that the concept of SANAD system is considered acceptable tool in particularly with Type 2 diabetes patients. A clinical evaluation study of SANAD system is also conducted in this thesis to evaluate the clinical effectiveness of the system. The primary aim of this study was to evaluate the effect of SANAD system on: 1) improve glycaemic control; 2) improve health awareness; and 3) enhance self-efficacy. Secondary aims qualitatively evaluated the content of communication in SANAD system. The key preliminary results of this study provided in evidence that SANAD has a positive impact on promoting knowledge of diabetes in individuals living with type 2 diabetes, and reflects the generally positive outcomes of reducing glycated hemoglobin control (HbAlc (%)), and increasing self-efficacy.

In the Middle Eastern Gulf Cooperation Countries, the prevalence of type 2 diabetes mellitus (T2DM) is increasing steadily. It has recently been estimated that up to 23% of the Saudi Arabian population meet the diagnostic criteria. Due to the potential for serious micro and macro-vascular complications such as peripheral vascular disease and nephropathy, T2DM places a significant burden on the individuals concerned and their families. In addition, T2DM is having catastrophic consequences for the health-care systems of many countries that are unable to cope with the increased demand for services. Furthermore, the prevalence is expected to increase and the burden of the disease is expected to worsen. As a consequence the Saudi government is implementing a number of strategies to address the issue, such as the National Plan to Combat Diabetes. The major problem is that T2DM is largely a lifestyle disease caused by an affluent diet and inactivity, and the goal of effective glycaemic control is impossible without competent patient self-management.This study identified factors affecting self-management practices among people who have T2DM in Almadinah, Saudi Arabia. The study had three phases. The first phase involved the development of a valid questionnaire instrument to measure diabetes self-management practices in Arabic speaking populations. The Summary of Diabetes Self-care Activities (SDSCA) instrument was translated into Arabic and validated according to the World Health Organisation’s Steps of Translation and Adaptation of Instruments. Two samples of T2DM participants were purposively recruited in this phase. The first sample consists of 33 while the second was 210 participants. Translation indicators showed satisfactory outcomes for each stage of the process.The Arabic Summary of Diabetes Self-care Activities (ASDSCA) instrument proved to have very acceptable psychometric properties: splithalf reliability (.90); test-retest (.912, p = <.001); and Cronbach’s alpha (.76). The internal consistency of the instrument’s sub-scales was good for diet (.89), exercise (.83), blood glucose testing (.92), and foot care (.77). Factor analysis revealed the presence of four components explaining 34.4%, 16%, 15.4%, and 11.2% of the variance of daily self-management practices for these items respectively (accumulated total of 77.1%). Based on these outcomes, the A-SDSCA was utilised in the second phase of the study.The second phase of the study measured diabetes self-management practices and identified socio-demographic factors affecting these practices. The sample of 210 T2DM participants purposively recruited from three primary health-care centres completed the A-SDCA (N=1,477). HbA1c scores indicated that only 30 (14.7%) participants had controlled blood glucose level (_ 7%). Bivariate analyses showed that blood glucose testing (85% _ four days/week) and exercise (47% _ two days/week) were the least practiced self-management activities. In contrast, selfmanagement levels were greatest for medication (75% 7days/week), diet (71% _ three days/week), and foot-care (56% _ three days/week). A regression model showed that high blood glucose level (-.122, p = .050) and smoking (-.192, p = .004) were negatively associated with self-management practices. On the other hand, being female (.321, p = .000) and having a good income (.129, p = .050) were positive factors. Overall, these factors accounted for 25% of the variability in everyday selfcare practices (R² = .251).The third phase further explored factors affecting self-management practices, not identified by the questionnaire alone. Using semi-structured interviews, qualitative data were collected from 24 T2DM participants and 12 health-care providers. Raw data were analysed by means of quantitative thematic analyses using the Chronic Care Model (CCM) as the conceptual framework. The result identified 30 sub-themes under the six CCM domains (themes). In total, 365 related statements were extracted. Major inputs were derived from health-care providers’ interviews (132 statements) followed by female (118 statements) and then male (115 statements) T2DM participants. Community domain was the most frequently identified theme (100 statements; 27%) while health system was the least frequently identified (38 statements; 10%). Factors relating to delivery system; decision making; clinical information system; and self-management represented 20%, 11%, 14% and 17% of the total identified statements, respectively.In conclusion, the fact that only 15% of participants had controlled glycaemic level despite a high level of dependence on medications is very good evidence that medication alone, is not the complete answer to the effective management of T2DM in the study context. The fact that the study participants demonstrated low levels of compliance with most other self-management practices indicates that they were facing difficulties and obstacles to practice optimal self-management activities. Furthermore, these findings reflect serious limitations in the way T2DM self-management is promoted and enhanced in the various study locations. The ASDSCA could be utilized by health-care researchers to measure self-management practices among T2DM people. Furthermore, the instrument might be used to measure improvements in self-management practices before and after self-management programs application.

Background: The prevalence of Type 2 Diabetes Mellitus (T2DM) is increasing globally, and the number of people with T2DM has increased particularly dramatically in Saudi Arabia in recent years. The International Diabetes Federation (IDF) has indicated that Saudi Arabia has a higher prevalence of diabetes than most other countries, with a prevalence rate of type 2 diabetes of 20.5% of the population in 2014. Adherence to self-care activities is the cornerstone of T2DM management, along with adopting a healthy lifestyle. This study thus aims to investigate the extent to which healthcare professionals and social support act as determinants of self-care among adults diagnosed with T2DM in Riyadh, Saudi Arabia. Methods: This study uses a concurrent triangulation design that combines quantitative and qualitative methods in a convenience sample of adults (N=388) diagnosed with type 2 diabetes mellitus who were recruited from two separate hospitals. Each participant completed a set of questionnaires and a Summary of Diabetes Self-Care Activities (SDSCA). Semi-structured interviews were also conducted with 10 male and 10 female participants (n=20) and 12 healthcare professionals. Results: Five themes emerged from the qualitative data analysis. The quantitative findings were then integrated to provide further explanations and context for these themes. The study indicated that poor adherence to diabetes self-care activities may lead to heightened incidence of uncontrolled T2DM among patients in Saudi Arabia. Culture and Religion, Gender, Stigma, Social Support, and Healthcare Environment all influenced adult diabetes adherence to self-care activities in Saudi Arabia. Conclusion: The results of this study show that the successful management of T2DM is dependent on support from family, spouses, friends, and healthcare professionals. The findings of this study therefore have implications for the creation and implementation of healthcare policy and practice in Saudi Arabia. These findings contribute to expanding existing knowledge by enabling healthcare providers to tailor diabetes self-care management educational programmes to best fit the psycho-social and cultural needs of adults in Saudi Arabia. It is particularly necessary for healthcare professionals in Saudi Arabia to recognise the roles played by gender, culture, religion and stigma, and to integrate these into any educational programmes.

Background Around 80% of the physicians working in Saudi Arabia providing primary health care are international medical graduates from other countries. They may not share their patients’ cultural background or language, yet are expected to deal with local patients with chronic health conditions, such as type 2 diabetes mellitus, who need culturally sensitive lifestyle advice. Study aim To explore and understand challenges and facilitators to effective communication between international medical graduates and patients with type 2 diabetes mellitus and how this may influence care provision in Saudi Arabia. Methods Data were collected in three phases: i) A focus group discussion with 6 international medical graduates from one hospital and 13 semi-structured interviews with international medical graduates from the hospital as well as 8 primary health care centres. ii) Semi-structured interviews with 16 Saudi patients with type 2 diabetes mellitus and iii) follow-up interviews with 5 international medical graduates. Data were analyzed with the aid of NVivo using thematic analysis. Findings Most of the international medical graduate participants reported that dealing with local patients was challenging because patients did not trust them for culturally-related reasons. Prejudice among local patients towards international medical graduates was identified, and this contributed to patients not acknowledging international medical graduates’ ability to provide culturally sensitive advice. Furthermore, some international medical graduates had a stereotypical view of local patients, which had led to an inflexible approach when advising patients. Both groups of participants identified contrasting expectations regarding relationship-building style. Participants also identified self-adopted strategies to overcome communication barriers and suggested new ones. Conclusion Findings suggest that efforts need to be targeted towards changing patient attitudes, as well as addressing the training needs of international medical graduates, in order to enhance the effectiveness of diabetes management and improve overall the delivery of health care in Saudi Arabia.

Saudi Arabia experiences insufficient effort in terms of patients’ education in relation to a number of prevalent diseases, including diabetes mellitus, musculoskeletal disorders and upper respiratory tract infections. In addition, the number of studies related to e-health initiatives to support patients in the Kingdom are limited and only benefit patients of a few hospitals. This situation leads to deficient application of self-management and education strategies to empower patients to manage their diseases. Unfortunately, such a deficiency can affect the health status in the Kingdom negatively as diabetes mellitus is reported as the first cause of death in the Kingdom among all other prevalent diseases. Although knowledge management has been proven to be a valuable approach to sharing knowledge and educating users to manage their illnesses, it has not been implemented appropriately to support the increasing number of diabetic citizens in Saudi Arabia. In this research, knowledge management is integrated with knowledge discovery to support specific needs of the diabetic community in the Kingdom. Such an integration constitutes an e-health initiative to support diabetic citizens and healthcare professionals to manage this expanding illness in Saudi Arabia. Knowledge discovery is implemented through data mining to elicit useful knowledge related to specific diabetes complications encountered by diabetic citizens in the Kingdom. The integrated framework applies the SECI model to capture and disseminate useful diabetes self-management and educational expertise to support the management of diabetes complications. This integrated approach to knowledge management and knowledge discovery has provided a valuable tool implemented in terms of a web portal. This has facilitated the exchange and dissemination of tacit and explicit knowledge of the diabetic community in the forms of strategies, guidelines and best practices. It has also overcome the issues faced by the organisational and national cultures affecting knowledge management practice in Saudi Arabia.

Background:Diabetes is a major public health problem in Saudi Arabia. One fifth (20%) of the Saudi population has diabetes and their healthcare takes almost a quarter (23%) of the total healthcare expenditure. A few sporadic small studies showed some evidence of suboptimal diabetes care. Aims:The aim of this study was to identify the deficiencies in diabetes care and the potential areas for quality improvement of service provision in Abha, a city representative of Saudi Arabia. Methods:A programme of research was undertaken using multiple research methods: semi-structured interviews with key stakeholders encompassing patients, healthcare professionals, managers and pharmacists; standard checklist for evaluating available resources; analysis of routine healthcare data; questionnaires to medical directors and healthcare leaders; and examination of the case notes of patients with diabetes. Results:The local registered diabetes prevalence was found to be lower than the national estimate (3.75% versus 14-25%). Almost three quarters (73%) of people with diabetes in Abha city have not been diagnosed. The vast majority (85%) of adult people with diabetes were either overweight or obese. Reviewing case notes of patients with diabetes at the primary health care centres (PHCCs) showed that only 4% had a record of HbA1c test and most patients (77%) did not achieve the recommended target of FBG of = 130 mg/dl (=7.2 mmol/l). Almost half the patients exceeded (47%) the recommended level of total cholesterol of = 195 mg/dl (5 mmol/l). Screening for diabetes complications is inadequate: foot examination was done for only 5.5%, neuro-examination for 37% and eye examination for 52%. Some medications e.g. mixed insulin and statins were not consistently available and inadequacies were identified in the provision of healthcare staff (e.g. dieticians and podiatrists) and laboratory resources (e.g. HbA1c test). Limited attention was given to health education and concerns were expressed about patient compliance. These findings were consistent across the multiple methods used. Conclusion:This study in Abha city found that a large number of Saudi patients with diabetes are not achieving recommended levels of glycemic, lipid and body mass index (BMI) control and are therefore at high risk of diabetes complications. Inadequate provision of laboratory facilities, drugs and patient education programmes compound these problems. Recommendations are made for strategies to improve both the structure and processes of diabetes care and the healthy behaviours of people with diabetes.

Introduction The incidence of T1DM in the Kingdom of Saudi Arabia (KSA) is particularly high at 36.99 per 100,000. The number of newly diagnosed cases in children (0-14 years) is estimated at 10,700 per year, constituting a major public health problem. Schools are important for secondary prevention, treatment and management of Type 1 Diabetes Mellitus (T1DM). Teachers need to be knowledgeable about diabetic emergences. Aim The aim of this study was to assess the impact of a health education programme on primary school teachers' knowledge and attitudes towards T1DM in children attending schools in Jeddah City, KSA. Methods A repeated measures non-equivalent groups design was adopted, with testing of the teachers at baseline, three month, and six month stages. Data was collected from 2013 to 2014. A structured, self-administered questionnaire was employed in Arabic. A total of 540 teachers were recruited in equal numbers by gender, of which 318 completed all test stages. The intervention consisted of a new and specially designed educational programme comprised of lectures and activities, with additional reading materials. SPSS was used for quantitative analysis of the data, and paired samples t-test and ANOVA were used to test for differences within and between experimental and control groups. Results No significant differences were found at the baseline pre-test stage between the groups in teachers' knowledge of T1DM in children, or their attitudes towards managing T1DM. The mean knowledge scores in the experimental group increased significantly at the post-test stage (three months), and again at the post-test 2 stage (six months). The mean knowledge scores of the control group fluctuated to some extent at the post-test and post-test 2 stages. The mean attitude scores in the experimental group showed significant increases at the post-test and post-test 2 stages, but there was no significant change in the mean attitude scores of the control group. Conclusion The results clearly demonstrate the effectiveness of the intervention in improving teachers' knowledge and attitudes about managing T1DM in schools. The inexpensive programme could be integrated into the Saudi national child health programme, and policy and practice recommendations are proposed to the Ministry of Education.

This qualitative study explored knowledge, attitude and practices of male T2DM patients in rural and urban populations of Riyadh, Saudi Arabia. Participants included 40 male patients aged 35 to 65 years with T2DM and 20 health care providers from rural and urban areas. Using a Grounded Theory approach three models were developed to describe the influences of T2DM management for rural patients; for urban patients and the perspectives of health care providers on T2DM management.

The prevalence of carbapenem resistance was investigated in A. baumannii strains isolated from diabetic patients in Saudi Arabia. 32% were resistant to imipenem (MIC 16-64 mg/L) and meropenem (MIC 4-64 mg/L). However, all isolates were sensitive to colistin and tigecycline. All isolates were highly resistant (MIC >128mg/L) to all remaining antimicrobial agents used in this study. Eleven imipenem-resistant isolates (MIC 16 – 64 mg/L) possessed the insertion sequence ISAba1; six of them possess bla_OXA-23 gene, and four also had ISAba2. One isolate (MIC 16mg/L) had bla_OXA-40 and ISAba1 and one imipenem-sensitive isolate (MIC 0.25mg/L) harboured ISAba2, ISAba3 and IS18. Twenty-three (61%) of both imipenem-sensitive and resistant isolates had ISAba1 whereas 28 (74%) clinical isolates had bla_ampC. All imipenem-resistant isolates were positive with amplification of the bla_VIM gene by PCR and this was confirmed by sequencing where the gene was confirmed as bla_VIM-2. Ten strains possessed four novel bla_OXA-51-like genes encoding ß–lactamases deposited in the GenBank nucleotide database under accession numbers: EU547443(OXA-90), EU547445 (OXA-130), EU547446 (OXA-131) and EU547447 (OXA-132). The multi-drug-resistance A. baumannii (MdRAB) strains from the diabetic patients showed the highest and broadest growth capabilities, multiplying equally well at critically high glucose levels as well as at low levels. That was in direct comparison with seven control strains, A. baumannii from non diabetics. A. baumannii sensitive strain, MRSA-15, MRSA-16, S. aureus, P. aeruginosa and E. coli. These results suggest that MdRAB has the ability not only to grow successfully in the presence of glucose but also to maintain this capability at all concentrations found within the fluctuating levels of diabetic patients. This suggests the condition of diabetes may preferentially select MdRAB over sensitive strains and also over other multiresistant pathogens. The bla_OXA-23 genes were more frequent (16%) than bla_OXA-40 (2.6%) and no bla_OXA-58 were identified. All bla_OXA-23 strains also harboured bla_VIM-2 enzymes.

ABSTRACT: Background: Depression is a common disorder with more than 300 million people worldwide. The comorbidity of depression and diabetes has a high prevalence rate. Collaborative care in diabetes should include screening for depression and patients with depression should be screened for diabetes for better patients care outcome. Objective: To identify the effect of diabetes mellitus on the depression presentations in the primary-care centers. Method: A case-control study was conducted at 11 PHC centers during April-May, 2017. Out of 185 patients who fulfill the study criteria, 74 who had depression with co-morbid with diabetes formed the Case-sample, 111 depressed patients not co-morbid formed the Control sample. PHQ-9 used as the diagnostic tool for depression. The satisfaction level and patients’ file were assessed and explored the diagnosed and missed cases by the PHC doctors. Data were analyzed using SPSS version 20. Odds ratios (OR) demonstrated with their 95% confidence intervals (CI) and P–value < 0.05. Results: Comorbid depression and diabetes have a significantly high mean of TG and HbA1c. Physical activity and sleep pattern were better among comorbid cases. At the same time, they were unsatisfied with their care in the PHC centers. Most of the depressant patients were missed by their PHC doctors (74%), that worse when the patients had comorbid with diabetes (85%) with significantly different (p-value=0.005). Conclusion: In diabetic patients, depression is mostly missed by the PHC physicians. Therefore, depression should be predicted in diabetic patients particularly, uncontrolled diabetes, unsatisfied patients. integrated depression management in diabetic care is necessary to improve clinical outcomes and reduce the burden of illness