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Since their inception in the commercial market in the mid-twentieth century, sulfonylureas (SUs) have remained a therapeutic option in the management of type 2 diabetes (T2D). Despite their established glucose-lowering effects, there is no consensus among global experts and modern guidelines regarding the priority of SUs in relation to other therapeutic options, given the lack of evidence that SUs are associated with a low risk of macrovascular events and excess mortality. However, findings from recent trials and real-time observations have resolved this contentious issue somewhat, albeit to varying degrees. The present consensus discusses the role of SUs in contemporary diabetes management in the Gulf Cooperation Council (GCC) countries. Regional experts from these countries gathered virtually to formulate a consensus following presentations of topics relevant to SU therapy with an emphasis on gliclazide, including long-term efficacy, cost, end-organ benefits, and side effects, based on up-to-date evidence. The present narrative review reflects the conclusions of this assembly and provides a platform upon which future guidelines for the use of SUs in the GCC can be tailored.

Aims The study aimed to assess the effectiveness of the Flash Glucose Monitor (FGM) in empowering patients with Type 1 Diabetes Mellitus (T1DM) to fast safely during the month of Ramadan. Methods In this prospective interventional study, eligible adult patients with T1DM were monitored with FGM and completed a survey after Ramadan. Time in range, glucose variability, changes in HbA1c, and renal function was evaluated. IRB approval and informed consent were acquired prior to the study. For data analysis (SPSS) Version 25 was used. Results The study included 8 adults (5 females, 3 males). The use of FGM enabled 25% of patients who were not able to fast in the previous year to fast in the current year.The median frequency of hypoglycemic episodes increased during Ramadan from 8 to 24 (p-value 0.049), however. Glucose variability during Ramadan was reduced by 4.05 ± 7.00 % but was not significant (p-value 0.17). The time in range before Ramadan was 51.00% ±10.75, during Ramadan was 53.42% ±14.83,and post-Ramadan was 55.85%± 10. HbA1cand creatinine did not change before and after Ramadan, (p-values of 0.465 and 0.315 respectively) indicating that glycemic control and renal function were maintained. Conclusion Active glucose monitoring using FGM coupled withstructured pre-Ramadan counseling and patient education aids in empowering patient to fast safely and maintain glycemic control during month of Ramadan and avoid complications including DKA and severe hypoglycemia. Keywords: Diabetes Mellitus; Flash glucose monitoring; Fasting, Ramadan; Time in Range.

Introduction: Hyperglycaemia in pregnancy (HIP) is the most common medical disorder complicating pregnancy. This includes women who have pre-existing Type 1 and Type 2 diabetes mellitus (DM) and those diagnosed to have gestational diabetes mellitus (GDM), with glucose intolerance identified for the first time in pregnancy. In the Middle East and North Africa region, the prevalence of DM in women of reproductive age group is high and it varies widely between different regions due to variation in screening and diagnostic criteria for the identification of GDM. Universal blood glucose screening at first antenatal booking visit helps in identifying women with HIP. Women who are screen negative at first antenatal should subsequently be screened with a fasting oral glucose tolerance test (OGTT) around 24-28 weeks to identify GDM. There is a clear evidence that the identification and management of hyperglycaemia improves pregnancy outcomes. Antenatal care involves more visits as these women are at higher risk of fetal malformations, preterm labour and stillbirth. Timing of delivery is based on glycaemic control, fetal wellbeing, and the presence of co-morbidities. Objective: The objective of this article is to provide guidelines regarding the management of hyperglycemia in pregnancy. Materials and Methods: These recommendations are made after reviewing various existing guidelines including American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynecologists, and American College of Sports Medicine. A literature search was done using PubMed, Cochrane Database, Google Scholar, EMBASE, various systematic reviews, and original articles. Search was done using key words “Hyperglycemia in pregnancy,” “gestational diabetes mellitus,” and “diabetes in pregnancy.” Conclusion: Hyperglycemia in pregnancy can be managed effectively if appropriate measures are taken and potential consequences can be avoided.

Since their inception in the commercial market in the mid-twentieth century, sulfonylureas (SUs) have remained a therapeutic option in the management of type 2 diabetes (T2D). Despite their established glucose-lowering effects, there is no consensus among global experts and modern guidelines regarding the priority of SUs in relation to other therapeutic options, given the lack of evidence that SUs are associated with a low risk of macrovascular events and excess mortality. However, findings from recent trials and real-time observations have resolved this contentious issue somewhat, albeit to varying degrees. The present consensus discusses the role of SUs in contemporary diabetes management in the Gulf Cooperation Council (GCC) countries. Regional experts from these countries gathered virtually to formulate a consensus following presentations of topics relevant to SU therapy with an emphasis on gliclazide, including long-term efficacy, cost, end-organ benefits, and side effects, based on up-to-date evidence. The present narrative review reflects the conclusions of this assembly and provides a platform upon which future guidelines for the use of SUs in the GCC can be tailored.

Highlights • The COVID-19 pandemic creates a challenge to providing care for patients with diabetes. • Patients with diabetes are at a higher risk of complications due to COVID-19. • Telemedicine is a virtual care delivery service that can be developed quickly and adapted effectively to sustain the delivery of healthcare to patients with diabetes., Introduction The COVID-19 pandemic creates a challenge in the provision of care for patients with diabetes. Furthermore, those with uncontrolled diabetes are at a higher risk for complications due to COVID-19. The purpose of this study is to find an innovative method to sustain effective diabetes care services amidst the COVID-19 pandemic. Methods Outpatient diabetes care was successfully transformed from traditional face-to-face encounters in the clinic to an online telemedicine service. Results 1,972 patients were encountered over a 4-week study period during which we had a low proportion of unreached patients (4%). Some patients were still seen in person because they came as walk-in visits or insisted to be seen in person. Conclusion Telemedicine has become an essential healthcare service and could be augmented by the use of technology like web-based applications and communication via transfer of data from patients’ glucometer, insulin pumps, or sensors. Diabetes care can be transitioned to telemedicine effectively and would be successful in reaching more patients than by traditional face-to-face visits. This model of care is time consuming and unfortunately does not reduce the need for medical staff.

S.E., a 53-year-old Caucasian woman, was referred to the endocrinology clinic for management of type 2 diabetes. She was diagnosed 2 years ago and failed to achieve acceptable glycemic control with metformin and glipizide. Her glucose values ranged between 300 and 500 mg/dl. The patient expressed fear of not getting the care she needs to achieve her glycemic goal because of the stigma of alcohol dependence. S.E. had peripheral neuropathy but no history of nephropathy, retinopathy, or any macrovascular complications of diabetes. She has been drinking alcohol for the past 10 years. She reported that she has three 18-oz drinks per day, each composed of equal amounts of rum and regular cola. This is ~ 360 g of alcohol per day. She said she starts drinking from the time she wakes up until she goes to bed and has no intention of cutting back on the amount of drinking or enrolling in a detoxification program. On physical examination, her blood pressure was 147/82 mmHg and her BMI was 33 kg/m2. Her skin showed spider telangiectasia and no evidence of acanthosis nigricans or thyromegaly. Her abdomen was soft and non-tender, and she had no organomegaly. She was able to sense pressure from a 10-g monofilament in all of 10 points bilaterally. The rest of the examination was non-contributory. Laboratory results showed an A1C of 11%, creatinine of 1 mg/dl, albumin-to-creatinine ratio of 10.8 mg/g, aspartate transaminase of 113 IU/l, alanine aminotransferase of 69 IU/l, alkaline phosphatase of 276 IU/l, total bilirubin of 0.9 mg/dl, and thyroid-stimulating hormone of 2.04 μIU/ml. Her total cholesterol was 280 mg/dl, triglycerides were 805 mg/dl, HDL cholesterol was 15 mg/dl, and direct LDL cholesterol was 182 mg/dl. Her vitamin B12 level was > 1,500 pg/ml (reference range 250–900 pg/ml), and her folate level …

Background Multiple factors affect residency education, including duty-hour restrictions and documentation requirements for regulatory compliance. We designed a work sampling study to determine the proportion of time residents spend in structured education, direct patient care, indirect patient care that must be completed by a physician, indirect patient care that may be delegated to other health care workers, and personal activities while on an inpatient general practice unit. Methods The 3-month study in 2009 involved 14 categorical internal medicine residents who volunteered to use personal digital assistants to self-report their location and primary tasks while on an inpatient general practice unit. Results Residents reported spending most of their time at workstations (43%) and less time in patient rooms (20%). By task, residents spent 39% of time on indirect patient care that must be completed by a physician, 31% on structured education, 17% on direct patient care, 9% on indirect patient care that may be delegated to other health care workers, and 4% on personal activities. From these data we estimated that residents spend 34 minutes per patient per day completing indirect patient care tasks compared with 15 minutes per patient per day in direct patient care. Conclusions This single-institution time study objectively quantified a current state of how and where internal medicine residents spend their time while on a general practice unit, showing that residents overall spend less time on direct patient care compared with other activities.