Background: Previous reports suggest that the Coronavirus Disease-2019 (COVID-19) pandemic might have affected incidences of diabetic ketoacidosis (DKA) and new diagnoses of type 1 diabetes. This systematic review and meta-analysis aimed to estimate the risk of DKA, including severe DKA, during the COVID-19 pandemic versus the prior-to-COVID-19 period among pediatric patients with type 1 diabetes.Methods: PubMed and EMBASE were searched for observational studies investigating the risk of DKA among pediatric patients with type 1 diabetes during the COVID-19 pandemic and the prior-to-COVID-19 period. A random meta-analysis model was performed to estimate the relative risk of DKA during the COVID-19 pandemic compared to before the pandemic. Subgroup analyses were conducted based on the type 1 diabetes status, established or newly diagnosed. In addition, sensitivity analysis was conducted for studies that reported results from adjusted analysis for potential confounders using fixed effect model.Results: A total of 20 observational studies reported the risk of DKA, of which 18 reported the risk of severe DKA. The risks of DKA and severe DKA were 35% (RR 1.35, 95%CI 1.2-1.53, I² = 71%) and 76% (RR 1.76, 95%CI 1.33-2.33, I^{2 =} 44%) higher in the during-COVID-19 group compared to the prior-to-COVID-19 group, respectively. Among patients with newly diagnosed type 1 diabetes, the risk of DKA was 44% higher for the during-COVID-19 group compared to the prior-to-COVID-19 group (RR 1.44, 95%CI 1.26-1.65; I² = 64%). Only two studies reported the risk of DKA among patients with established type 1 diabetes and the cumulative risk was not statistically significant. In the sensitivity analysis, four studies reported an adjusted odds ratio (aOR) of the risk of DKA during COVID-19 compared to the prior-to-COVID-19 period. The fixed estimate from the meta-analysis found an increase in the risk of DKA in the during-COVID-19 group compared to the prior-to-COVID-19 group (aOR 2.04, 95%CI 1.66-2.50).Conclusions: This study showed that DKA risk, especially the risk of severe DKA, has increased significantly during the pandemic. Healthcare systems must be aware and prepared for such an increase in DKA cases and take all necessary measures to prevent future spikes during the pandemic.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=272775, identifier PROSPERO [CRD42021272775].

Background: GLP-1 receptor agonists (GLP-1RA) are used in the management of type II diabetes mellitus or obesity, although its role in patients with type I diabetes mellitus (T1DM) has been debated. This study aimed to investigate the efficacy and safety of GLP-1RA in patients with T1DM using real-world data. Methods: This multicenter, retrospective study was conducted at three tertiary medical centers in Riyadh, Saudi Arabia. The study followed up patients (>16 years old) with T1DM treated with insulin followed by GLP-1RA add-on therapy. The efficacy outcomes included changes in HbA1c, body weight, and insulin requirements from baseline to each follow-up visit. The main safety outcomes assessed included hypoglycemic events and gastrointestinal (GI) adverse events. Results: The study included 144 patients with a mean age of 33.0 ± 10.1 years. Semaglutide was the most used GLP-1RA (63.9%) followed by liraglutide (34.0%). From baseline to 3-month follow-up, HbA1c (mean difference (MD) = −0.8%; p = 0.0053), weight (MD = −2.4 kg; p = 0.0253), and daily basal insulin dose (MD = −2.1 units; p = 0.0349) were significantly reduced. Likewise, HbA1c (MD = −0.5%; p = 0.0004), weight (MD = −3.6 kg; p < 0.0001), and daily basal insulin (MD = −2.4 units; p = 0.0282) were significantly reduced at the 4–6-month follow-up. The significant reductions in HbA1c, weight, and daily basal insulin levels were consistent for up to 18-month follow-up. Only one patient had a major hypoglycemic event, whereas 8.3% of the patients had GI adverse events. Conclusions: Overall, significant improvements in glycemic control, weight loss, and insulin requirements were observed with the use of GLP-1RA in patients with T1DM, with a limited number of GI adverse events.

The study aims to comparatively assess the nephrotoxicity of vancomycin when combined with piperacillin-tazobactam (V + PT) or meropenem (V + M) in adult patients hospitalized in general wards or intensive care units. We searched MEDLINE, Google Scholar, and Web of Science for observational studies evaluating incidences of AKI in adult patients receiving V + PT or V + M for at least 48 h in general wards or intensive care units. The primary outcome was AKI events, while the secondary outcomes were hospital length of stay, need for renal replacement therapy (RRT), and mortality events. The odds ratio (OR), or mean difference for the hospital length of stay, with a corresponding 95% confidence interval (CI) from the inverse variance weighting random-effects model were estimated for the risk of AKI, RRT, and mortality. Of the 112 studies identified, twelve observational studies were included in this meta-analysis with a total of 14,511 patients. The odds of having AKI were significantly higher in patients receiving V + PT compared with V + M (OR = 2.31; 95%CI 1.69–3.15). There were no differences between V + PT and V + M in the hospital length of stay, RRT, or mortality outcomes. Thus, clinicians should be vigilant while using V + PT, especially in patients who are at high risk of AKI.

Background: Patients with prediabetes are at higher risk of developing type 2 diabetes. While intensive lifestyle modification is the primary approach to delaying diabetes, metformin has been shown to be effective, especially among patients younger than 60 years and obese (body mass index (BMI) > 35 kg/m²), patients with fasting blood glucose ≥ 6.1 mmol/L or HbA1c ≥ 6%, and women with history of gestational diabetes. Thus, metformin is now recommended as an option for diabetes prevention by the American Diabetes Association (ADA). The use of metformin among patients with prediabetes in Saudi Arabia and their adherence to the guideline's recommendation for the prevention of type 2 diabetes is unknown. This study aimed to identify the prevalence of metformin use among prediabetes patients overall and patients who are more likely to benefit from metformin use per the ADA guidelines.Methods: A retrospective cohort study was conducted encompassing data from three tertiary care hospitals between January 2015 and June 2019. All patients aged 20 to 70 years with prediabetes (HbA1c of 5.7–6.4%) were included, while patients with an established diagnosis of diabetes, creatinine clearance <45 ml/min, using antihyperglycemic medications other than metformin, or on metformin for other indications were excluded. Prediabetes patients who are most likely to benefit from metformin for type 2 diabetes prevention are those younger than 60 years with a BMI ≥ 35 kg/m², patients with fasting blood glucose ≥ 6.1 mmol/L or HbA1c ≥ 6%, and women with history of gestational diabetes. This study examined the prevalence of metformin use among all patients with prediabetes, as well as patients who would be more likely to benefit from metformin use per the ADA guidelines.Results: A total of 251 patients were included in this study; 52.2% were female, with a mean age of 47.0 (11.9) years and BMI of 32.3 (6.5) kg/m², and the median HbA1c at baseline was 5.8% (5.7–6.0). Among the overall sample, 18 patients (7.2%) received metformin for the prevention of type 2 diabetes, 14 of those were from the groups that are more likely to benefit from metformin use per the ADA guidelines (9.9%).Conclusions: Among individuals with prediabetes in Saudi Arabia, metformin use was very low despite the evidence supporting its safety, convenience, and efficacy. Healthcare providers seemed hesitant to medicalize prediabetes; furthermore, the low use of metformin suggests the existence of several barriers that need to be identified and resolved. Increasing providers' knowledge and awareness regarding screening and management of prediabetes is highly encouraged.

To perform a cost of control analysis of glucagon like peptide-1 receptor agonists (GLP1RA) in Saudi Arabia (SA) and determine the economic impact of adopting GLP1RAs. A budget impact model that captures the cost of control model was constructed to simulate hypothetical patient on six treatment options: a current mix of 60% liraglutide and 40% dulaglutide, semaglutide, liraglutide, dulaglutide, exenatide, and lixisenatide. We estimated the relative amounts of SAR spend to achieve HbA1c targets (≤6.5% or < 7.0%). For each treatment option, annual treatment cost, proportion of patients achieving HbA1c targets, and cost to treat major adverse cardiovascular events (MACE) were aggregated to estimate the cost of control per patient per year (CCPPPY) over 5-year horizon (2021–2025). Probabilistic sensitivity analysis (PSA) was performed as a confirmatory analysis. The CCPPPY to achieve HbA1c ≤ 6.5%/<7.0% using current mix, semaglutide, liraglutide, dulaglutide, exenatide, and lixisenatide were SAR 17,097/SAR 14,113, SAR 12,889/SAR 11,123, SAR 15,594/SAR 12,892, SAR 19,184/SAR 15,940, SAR 580,211/SAR 380,936, and SAR 246,570/SAR 143,759, respectively. The relative amounts of SAR spend to achieve HbA1c ≤ 6.5%/<7.0% relative to 1 SAR on semaglutide in case of adopting current mix, liraglutide, dulaglutide, exenatide, and lixisenatide were SAR 1.42/SAR 1.18, SAR 1.30/SAR 1.07, SAR 1.60/SAR 1.33, SAR 48.33/SAR 31.73, and SAR 20.54/SAR 11.97, respectively. These results were confirmed in the PSA. Semaglutide 1 mg once weekly was the most economically favorable GLP1RA; associated with the least CCPPPY, and amount of SAR spent to achieve HbA1c of ≤6.50%/<7.00% versus all other GLP1RAs.