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FreeStyle Libre 1 (FGM) has been approved by the FDA for children older than 4 years. It enables noninvasive glucose monitoring without the need for finger pricking. Parents of very young children often use the device off-label. Thus, we aimed to evaluate the safety of and user experience with FreeStyle Libre® 1 and determine its impact on sleep and glycemic control. This was an ambi-directional cohort study. We recruited parents of very young children with type 1 diabetes mellitus (T1DM) who were less than 5 years old when they started using FGM at the King Saud University Diabetes Center. The parents filled out a survey evaluating their experience with the system. In addition, the glucose metrics of the children were also obtained from the Libre View system. We included 31 children with mean age of the children when they started using FGM was 3.88 ± 1.10 years (range, 1.46–5.4 years), and the mean sensor use was 2.3 ± 1.3 years. During the use of the device, the parents had increased sleep duration of 0.71 h (p-value=0.04), had earlier bedtime by 2.8 h (p-value=0.04), and were able to sleep in a separate room from their children. In addition, the time in range improved by 9.9%, the time above range decreased by 8.8%, and the HbA1c level reduced by 1.56%. The safety profile of FGM used for very young children with T1DM is the same for older children, which leads to improved metabolic control and sleep quality of both the parent and the child. [ABSTRACT FROM AUTHOR]

We aimed to report our 10-year experience of treating short children born small for gestational age (SGA) by comparing the long-term growth, metabolic safety, and cost-effectiveness of recombinant human growth hormone (rhGH) therapy in short children born SGA with those in rhGH-treated children with growth hormone deficiency (GHD) and Turner syndrome. We performed a 10-year retrospective cohort study at King Saud University Medical City. We included children aged 3–16 years who received rhGH for GHD, SGA, or Turner syndrome for >1 year. A total of 166 children received rhGH therapy for GHD, 58 for SGA, and 16 for Turner syndrome. During the last study visit, the average height change was 21 cm for GHD children and 14 cm for children born SGA (p-value <0.001). The height SDS change was 0.84 for GHD children and 0.55 for SGA children (p-value=0.004). The average cost-effectiveness ratios for treating GHD and SGA children were USD 1,717.22 and USD 1,157.19 per centimeter gained, respectively. Moreover, the mean incremental cost-effectiveness ratio for GHD vs. SGA patients was USD 2,820.39 per centimeter gained. Dysglycemia developed in 70 patients: 43 (36.44%), 22 (40.74%), and 5 (13%) in the GHD, SGA, and Turner syndrome groups, respectively. rhGH is effective in height improvement of short children. However, pursuing rhGH treatment for children born SGA requires a shared decision-making approach to balance the modest benefit of final adult height gain with the long-term metabolic effects, considering the acceptable costs on the Saudi healthcare system. [ABSTRACT FROM AUTHOR]

Semaglutide, a Glucagon-like Peptide-1 Receptor Agonist (GLP-1 RA), is often prescribed for managing type 2 diabetes, particularly in cases unresponsive to other hypoglycemic agents. Despite its popularity, the real-world efficacy and cost-effectiveness of Semaglutide relative to other treatments remain understudied. This study aimed to examine the direct medical cost and consequences of adding Semaglutide to the treatment regimen for patients with type 2 diabetes in Saudi Arabia. We conducted a single-center, retrospective review of Electronic Medical Records (EMRs) for adults with type 2 diabetes. Patients who had been on Semaglutide for at least three months were matched with those receiving alternative hypoglycemic therapies. Exclusions were made for patients with cancer, incomplete EMRs, or lacking prescription data. Investigated outcomes included changes in HbA1C levels and weight, and the direct costs comprised medications, clinic visits, and emergency care. Baseline adjustments were made through inverse probability treatment weighting, and uncertainty was assessed via bootstrapping with 10,000 replications. Out of 350 patients meeting the criteria, 116 were on Semaglutide. Predominantly females (62%), the cohort had an average age of 60 and a disease duration of 22 years. The difference in HbA1C (%) reductions between Semaglutide and non-Semaglutide users over 3,6, and 12 months were 0.154 (95% CI: –0.452-0.483), –0.031(95% CI: –0.754-0.239), –0.16(95% CI: –1.425-0.840), respectively. Semaglutide users did experience modest weight reductions ranging from 0.42 kg to 1.16 kg. The annual additional direct medical cost for Semaglutide was USD 4,086.82 (95% CI: $3,710.85 - $4,294.99). Although Semaglutide induced modest weight reductions, it did not offer significant advantages in lowering HbA1C levels compared to other hypoglycemic treatments. These findings suggest the need for further research involving larger and more diverse cohorts to corroborate these findings. [ABSTRACT FROM AUTHOR]

Background: The growth hormone (GH) stimulation protocols for clonidine and arginine tests are non-standardized and can be lengthy. We examined the specificity of both tests using a shorter duration of timed samples: 90 min for clonidine and 60 min for arginine. Methods: We retrospectively studied all children who had GH stimulation with clonidine and arginine to test for GH deficiency (GHD). We compared the diagnostic accuracy of both reference and new shortened test (index). Results: We reviewed 243 charts (11.4±4.1 years old; 74.5% males). The combined reference test was performed on 159 children, 29 (18.3%) tested positive for GHD on the combined index test, Kappa 0.98, false positive rate 1 (0.8%), specificity 0.99, 95th CI (0.96-1), and p = 1.0. The specificity of both the clonidine and arginine single index tests was 0.98%. Conclusions: The shortened clonidine and arginine stimulation index tests have good specificity. This is a viable option for testing children for GHD. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of dementia is expected to increase exponentially in developing countries over the next few decades.1, 2 Arabic language is widely spoken across the middle east and north Africa, where dementia diagnosis remains challenging.3 Many factors contribute to the underdiagnosis of dementia in Arabic speaking countries including the lack of validated functional assessment tools for patients with cognitive impairment.2, 4 The aim of this study is to translate, cross culturally adapt and validate the widely used Bristol Activity Of Daily Living Scale (BADLS)5 to the Arabic language. Methods: First the BADLS was translated to the Arabic language by two independent bilingual experts. The Arabic version was then back translated to English by two independent translators. Then reviewed by expert panel including the original author to keep original meanings, check accuracy and standardization. A pilot study was done for Cognitive Debriefing. Expert panel discussion was done to review cognitive debriefing and finalize. Criterion validity is tested against the validated Arabic version of the Katz Index of Independence in Activities of Daily Living and the Arabic version of the Montreal Cognitive Assessment (MOCA) test. Conclusion: To our knowledge this is the first study to translate the BADLS to the Arabic language. The Arabic BADLS will enable the early and accurate diagnosis of dementia for Arabic speaking patients and caregivers. References: 1. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet. 2020;396(10248):413‐446. 2. Epidemiology of Alzheimers Disease and Dementia in Arab Countries: A Systematic Review. Behavioural Neurology. 2019. 3. Benabdeljlil M. Assessment of cognitive disorders in the Arabic language. Journal of the neurological sciences. 2019;405(S):66‐67. 4. Abou‐Mrad F, Chelune G, Zamrini E, Tarabey L, Hayek M, Fadel P. Screening for dementia in Arabic: normative data from an elderly Lebanese sample. The Clinical Neuropsychologist. 2017;31(sup1):1‐19. 5. Bucks RS, Ashworth DL, Wilcock GK, Siegfried K. Assessment of Activities of Daily Living in Dementia: Development of the Bristol Activities of Daily Living Scale. Age Ageing Age and Ageing. 1996;25(2):113‐120. [ABSTRACT FROM AUTHOR]