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Thyrotoxic periodic paralysis (TPP) is an entity that has been described in the literature as a transient, symmetrical, flaccid paralysis, mainly affecting the lower limbs of patients with a current or previous history of hyperthyroidism. In most cases, Graves’ disease is the cause of hyperthyroidism. Contrast and iodine-induced TPP have been described in the literature, but only one case of intravenous contrast induced TPP has been reported. We report a case of TPP following administration of intravenous contrast for a computed tomography scan of the neck prior to lymph node excision. A 35-year-old Kuwaiti male with known Graves’ disease in remission until two months of his presentation, reported to the emergency room one early morning in December 2020. He sustained a fall from the stairs due to bilateral lower limb weakness, mostly proximal. The upper limbs were spared, and the patient did not experience any numbness or headache. His potassium was found to be 2.1 mmol/L and an electrocardiogram showed U waves and ST segment changes. He was initiated on 20 mEq of intravenous potassium chloride in 500 mL sodium chloride over one hour, following which his potassium approached normal and his weakness resolved. He was last known to be euthyroid in November 2019 but noted in October 2020 to be in the hyperthyroid state when thyroid function testing showed a thyroid-stimulating hormone of

Background Mounting evidence shows association between COVID-19 and new diagnoses of diabetes. It is unclear, however, if COVID-19 increases detection of pre-existing diabetes or if it can induce new-onset of the disease. Methods We established a global online registry of COVID-19-related diabetes (CoviDIAB) using a web-enabled data capture system (Dendrite Clinical Systems). In this study we aimed to investigate whether COVID-19 can induce new-onset diabetes, its subtypes and clinical manifestations. To this end, we analyzed clinical and laboratory data from cases of newly-diagnosed diabetes occurring during or within four weeks from an episode of COVID-19. To exclude pre-existing hyperglycaemia, new-onset diabetes was defined as: blood sugar levels above diabetes thresholds (fasting glycaemia ≥ 126 mg/dL or non-fasting glycemia > 200 mg/dL), no prior history of the disease or use of glucose-lowering medications, and HbA1c The CoviDIAB registry is accessible online at http://covidiab.e-dendrite.com.

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.

Introduction To analyse the safety and effectiveness of gliclazide modified release (MR) in adults with type 2 diabetes mellitus participating in Ramadan from three geographically and culturally different regions of the world included in the DIA-RAMADAN study. Methods DIA-RAMADAN was a real-world, observational, international, non-comparative study. The global study population was divided into three regional subgroups, with data gathered at inclusion 6–8 weeks prior to Ramadan (V0), during Ramadan (4.5 weeks) and 4–6 weeks after Ramadan (V1). Primary endpoint was the proportion of patients reporting ≥ 1 symptomatic hypoglycaemic events (HE), which were collected using a patient diary along with other adverse events. Results Patient numbers from the three regions were n = 564 (46.5%; Indian sub-continent), n = 354 (29.1%; Middle East) and n = 296 (24.4%; South-East Asia). Patient baseline characteristics, demographics, fasting habits and antidiabetic treatments varied between regions. There were similar proportions of symptomatic HE between regions, with no severe HE. Significant weight reductions were observed in all regions following Ramadan, along with reductions in HbA1c and fasting plasma glucose. Conclusion These real-world study data indicate that gliclazide MR is safe and effective for management of type 2 diabetes during Ramadan in all three regions studied as part of DIA-RAMADAN. Trial Registration Clinicaltrials.gov identifier NCT04132934. Infographic Supplementary Information The online version contains supplementary material available at 10.1007/s13300-021-01067-1.

Insulin autoimmune syndrome (IAS) is a disease characterized by hyperinsulinaemic hypoglycaemia associated with autoantibodies against endogenous insulin. We have described a case of a 25-year-old, previously healthy Kuwaiti man who was admitted to the Mubarak Al-Kabeer hospital with a history of recurrent hypoglycaemia. The patient revealed that he had taken several different injectable anabolic steroids and growth hormone with oral amino acids and other tablets (fat burners) for bodybuilding in the last two months. He denied knowingly using insulin or insulin analogues. The patient had elevated fasting insulin level (>301 uIU/mL) and elevated insulin autoantibodies (>100.0 IU/mL). After appropriate work-up, he was diagnosed with IAS. After treatment with prednisolone (1 mg/kg/day), the patient had complete recovery. In patients with repeated hypoglycaemia, IAS should be considered in the differential diagnosis. Glucocorticoid therapy can be effective for the treatment of hypoglycaemia in patients with IAS.

Introduction: Advancing treatment from basal insulin (BI) to premix insulin may improve glycemic control, though at the expense of greater hypoglycemia risk, including nocturnal hypoglycemia. Methods: SoliMix was a 26-week open-label, multicenter, randomized trial comparing iGlarLixi vs. premix insulin analog (BiAsp 70/30) in adults with T2D and HbA1c ≥7.5-≤10 % on BI + oral antihyperglycemic drugs (OADs). Primary results showed that switching to once-daily iGlarLixi resulted in better glucose control vs. twice-daily BiAsp 70/30. This subanalysis assessed nocturnal hypoglycemia (defined as bedtime-waking or 00:00-06:00 h [any; any symptomatic; ADA Level 1, 2, 3]) during the 26-week study period. Results: Incidence and rates of ADA Level 2 and any symptomatic nocturnal hypoglycemia were lower with iGlarLixi vs. BiAsp 70/30 for both nocturnal time intervals (Table). Incidence and rates of any and Level 1 nocturnal hypoglycemia were lower with iGlarLixi vs. BiAsp 70/30 between 00:00 and 06:00. No nocturnal ADA Level 3 (severe) hypoglycemia occurred in either treatment arm. Conclusions: Switching to iGlarLixi resulted in better glucose control with less nocturnal (00:00-06:00) hypoglycemia vs. premix insulin analog. A reduction in ADA Level 2 and any symptomatic hypoglycemia was also observed for the more clinically relevant window of bedtime to waking. Disclosure R. J. Mccrimmon: Advisory Panel; Self; Novo Nordisk Inc., Sanofi-Aventis, Board Member; Self; Novo Nordisk Foundation, Research Support; Self; AstraZeneca. J. Rosenstock: Board Member; Self; Applied Therapeutics, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Intarcia Therapeutics, Inc., Novo Nordisk, Oramed Pharmaceuticals, Inc., Sanofi, Consultant; Self; Applied Therapeutics, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Intarcia Therapeutics, Inc., Novo Nordisk, Oramed Pharmaceuticals, Inc., Sanofi, Research Support; Self; Applied Therapeutics, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Genentech, Inc., Intarcia Therapeutics, Inc., Lexicon Pharmaceuticals, Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk, Oramed Pharmaceuticals, Inc., Pfizer Inc., REMD Biotherapeutics, Sanofi. A. Y. Cheng: Advisory Panel; Self; Abbott, AstraZeneca, Bayer Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, HLS Therapeutics Inc., Janssen Pharmaceuticals, Inc., Medtronic, Merck & Co., Inc., Merck Sharp & Dohme Corp., Novo Nordisk, Sanofi, Research Support; Self; Applied Therapeutics, The Medicine Company, Speaker’s Bureau; Self; Abbott, AstraZeneca, Bausch Health, Canada, Bayer Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, HLS Therapeutics Inc., Janssen Pharmaceuticals, Inc., Medtronic, Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk, Sanofi. V. Fonseca: Consultant; Self; Abbott Diabetes, Asahi Kasei Corporation, Bayer Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Intarcia Therapeutics, Inc., Novo Nordisk, Pfizer Inc., Sanofi-Aventis, Stock/Shareholder; Self; Amgen Inc., Bravo4health, Mellitus Health. R. Choza: None. T. Alessa: Advisory Panel; Self; AstraZeneca, Eli Lilly and Company, Novo Nordisk, Sanofi-Aventis, Research Support; Self; Servier Laboratories, Speaker’s Bureau; Self; AstraZeneca, Eli Lilly and Company, Novo Nordisk, Sanofi-Aventis, Servier Laboratories. A. Alvarez: Employee; Self; Sanofi. E. Souhami: Employee; Self; Sanofi, Stock/Shareholder; Self; Sanofi. A. H. Boss: Employee; Self; Sanofi, Stock/Shareholder; Self; Novo Nordisk A/S. P. Picard: None. Funding Sanofi (EudraCT 2017-003370-13)

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.

A consensus platform is provided by the experts of the Gulf Cooperation Council (GCC) countries’ respective osteoporosis societies, on which specific guidelines can be developed further for regional use on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis. Guidance is provided in a Gulf Cooperation Council (GCC) country setting on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis, which is an adaptation of the European guidance by Kanis et al., jointly published by the International Osteoporosis Foundation and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). The respective osteoporosis societies of the Gulf Cooperation Council (GCC) countries assembled for a unifying consensus on the diagnosis and management of osteoporosis in postmenopausal women for the region. The Chair for Biomarkers of Chronic Diseases (CBCD) in King Saud University (KSU), Riyadh, Kingdom of Saudi Arabia (KSA), in cooperation with the Saudi Osteoporosis Society (SOS), hosted regional experts and respective leaders from different GCC osteoporosis societies, together with an adviser from the ESCEO. An assembly of experts representing the different osteoporosis societies from Saudi Arabia, the UAE, Bahrain, Oman, and Kuwait gathered on February 15–16, 2019 in Riyadh, KSA for the formulation of a general osteoporosis consensus for the region. The following areas were covered: diagnosis of osteoporosis and assessment of fracture risk; general and pharmacological management of osteoporosis; and hip fractures, vitamin D, recommendation on which FRAX tool to follow, and the importance of country-specific FRAX® and fracture liaison services for secondary fracture prevention. A platform is provided on which specific guidelines can be developed for regional use in GCC.

Aims To explore the real-world safety and effectiveness of gliclazide modified release (MR) in patients with type 2 diabetes mellitus (T2DM) fasting during Ramadan. Methods DIA-RAMADAN (NCT04132934) was a prospective, international, observational study conducted in nine countries. Patients >18 years of age with T2DM (N = 1244) were examined at an inclusion visit (V0) occurring 6–8 weeks before the start of Ramadan. Patients received a diary to report treatment changes, hypoglycaemic events (HEs), and other adverse events. Gliclazide MR was taken once daily for 14–18 weeks. A second visit (V1) was conducted 4–6 weeks after the end of Ramadan. The primary endpoint was the proportion of patients reporting ≥1 symptomatic HE. Changes in HbA1c, fasting plasma glucose (FPG), and body weight were secondary endpoints. Results The proportion of patients reporting ≥1 symptomatic HE during Ramadan was low (2.2%) with no reported severe HEs. There was a significant reduction in HbA1c (−0.3%), FPG (–9.7 mg/dL), body weight (−0.5 kg) and body mass index (−0.2 kg/m2) between V0 and V1 (p Conclusions Patients with T2DM treated with gliclazide MR during Ramadan have a low risk of hypoglycaemia and maintain glycaemic control and weight while fasting.

High HDL-cholesterol (HDL-C) based on the 85th percentile of the 2009-2010 National Health and Education Survey (NHANES) was present in more than a third of 194 unselected subjects with type 1 diabetes (T1D). Age was associated with an increase and Hispanic ethnicity with a decrease in the prevalence of high HDL-C.