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Aishah Ekhzaimy,1 Shadin Alkatari,1 Mohamed AlMaatouq,1 Daad Alotaibi,1 Sarah Aljasser,1 Amal Aseeri,1 Anwar Jammah,1 Muhammad Mujammami,1– 3 Mona Fouda,1 Assim A Alfadda,1,2,4 Riad Sulaimani1 1Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia; 2Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia; 3University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia; 4Obesity Research Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi ArabiaCorrespondence: Aishah Ekhzaimy, Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia, Email aishahekhzaimy@hotmail.comPurpose: Impact of ramadan fasting on healthy and women with diabetes is already known. However, there is a scarcity of data on impact of fasting on pregnant women with diabetes. Moreover, religious and medical recommendations advise pregnant women against fasting as it is unsafe. Despite being exempted, many pregnant Muslim women with diabetes still choose to fast during ramadan. This study investigated different glycemic marker as an indicator for diabetes control in fasting pregnant women.Patients and Methods: This is a prospective observational study. A total of 89 pregnant diabetes women were recruited. Blood glucose was self-monitored in all the pregnant women using glucose monitoring device at home. We measure the fructosamine, HbA1c levels before, during and after ramadan.Results: Pregnant women with type 1 diabetes were 14 (25%), type 2 diabetes were 21 (37.5%), and gestational diabetes were 21 (37.5%). The mean fructosamine level decreased during and after ramadan in gestation diabetes pregnant women compared to type 2 diabetes and type 1 diabetes pregnant women subjects (p = 0.009).Conclusion: The present study indicates that pregnant women with diabetes were able to fast during ramadan and there fructosamine level reduced during fasting. Utilization of fructosamine for short-term monitoring of glycemic control in addition to home glucose monitoring in pregnant women with diabetes will provide a good index of glycemic control.Recommendation: Religious and medical recommendations advise pregnant women against fasting as it is unsafe, and they are under high risk. However, if they insist to do fast, they must do under strict medical supervision and fructosamine can be used as a glycemic control marker.Keywords: ramadan fasting, gestational diabetes, type 2 diabetes, type 1 diabetes, pregnant women, fructosamine

Osteoporosis is the most common bone disease in humans. With its related fragility fracture, it represents a major public health problem in our region, with a significant medical and socio-economic burden. The high prevalence rate of vitamin D deficiency, the increase in life expectancy, the low socioeconomic level and the significant restriction to access to health care in some countries represent the major causes for the increasing prevalence of osteoporosis and incidence of fragility fractures in the Arabic countries. Bone mineral density (BMD) assessment is the gold standard to diagnose osteoporosis. However, a clinical diagnosis of osteoporosis may be made in the presence of a fragility fracture, without BMD measurement. Dual energy x-ray absorptiometry (DXA) is the preferred method for screening bone mineral density. For screening site of measurement, DXA of hip and spine is suggested. BMD assessment is recommended in all women 65 years of age and older and men 70 and older regardless of risk factors. Younger subjects with clinical risk factors and persons with clinical evidence of osteoporosis or diseases leading to osteoporosis should also be screened. These guidelines are aimed to provide to health care professionals in the region of an updated process for the diagnosis and treatment of osteoporosis. It includes risk factors for osteoporosis and the indications for screening, diagnosis of osteoporosis, treatment of osteoporosis in postmenopausal and premenopausal women, and men; in addition to prevention and treatment of glucocorticoid-induced osteoporosis.

Background Low bone mineral density (BMD) is a public health issue in Saudi Arabia. This study measured the prevalence and factors associated with low BMD in Saudi women in Riyadh, Saudi Arabia. Methods A cross sectional study using two stage cluster sampling technique was conducted in Riyadh, 2009. Thirty clusters, each comprising of 300 houses were randomly chosen and from each cluster 38–40 households were selected to identify 1150 women of >40 years. Women were invited to primary health care center for filling of self-administered questionnaire (n = 1069) comprising of sociodemographic, health, diet and physical activity variables. 1008 women underwent screening for low BMD using the quantitative ultrasound technique. 535 (53%) women with positive screening test were referred to King Khalid Hospital for Dual X-ray Energy absorptiometry (DXA). Results 362 women underwent DXA and 212 (39.6%) were screened low BMD either at lumbar spine or femur neck. Mean age of women was 55.26(±8.84) years. Multivariate logistic analysis found; being aged 61 to 70 years (OR 2.75, 95% CI: 1.32-1.48), no literacy (OR 2.97, 95% CI:1.44 - 6.12) or primary education (OR 4.12, 95% CI:2.05-8.29), history of fractures (OR 2.20, 95% CI:1.03- 4.69) and not drinking laban(diluted yogurt) (OR 2.81, 95% CI:1.47- 5.37) significantly associated with low BMD. Conclusions Women with low level of education, who do not drink laban and had history of fractures were at high risk of low BMD.

This study was conducted in Riyadh to determine the prevalence of diabetes mellitus and impaired glucose tolerance. Blood samples (3981) were collected from Saudi male and female adults (2402) and children (1579) during a household screening program conducted over a period of two years from September 1991 to September 1993. Fasting blood samples were collected and each individual was given an oral glucose load. Two-hour postprandial blood glucose was estimated and the World Health Organization (WHO) criteria were used to diagnose diabetes and impaired glucose tolerance. The diabetic patients were further grouped into noninsulin-dependent diabetes mellitus (NIDDM) and insulin-dependent diabetes mellitus (IDDM) depending on the age of onset and mode of treatment. The overall prevalence of diabetes mellitus (IDDM and NIDDM) was 4.76% in males and 4.10% in the females in the two-to 70-year age group. Ten individuals of the 3981 were suffering from IDDM, giving an incidence of two to three per 1000. When the children14 years were removed, the prevalence increased to 8.235% and 6.476% in the males and females respectively, while in the30 year old group, the prevalence increased to 16.0% and 12.34% in the males and females. Further significant increase in NIDDM and impaired glucose tolerance (IGT) was observed with age (P0.05). NIDDM was more frequent in males while IGT was more frequent in females. This paper presents the results of screening in Riyadh and stresses the need for diabetes mellitus awareness programs in the Saudi population.