Saudi Cultural Missions Theses & Dissertations
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Item Restricted Prevalence of Prediabetes and Type 2 Diabetes Among Undiagnosed Schoolteachers in Riyadh, Saudi Arabia(Saudi Digital Library, 2025) Aldekhayel, Ghassan; Farragher, Tracey; Verma, Arpana; Greenhalgh, Christine; Azmi, ShazliBackground: Diabetes Mellitus (DM) is an important public health issue in the Middle East region because of its high prevalence. In Saudi Arabia, the prevalence of type 2 DM among adults is 23.1%, and is one of the top ten causes of mortality. Patients with type 2 DM may remain undiagnosed for many years, due to its asymptomatic nature especially in the early stages. It is estimated that nearly half of adults with type 2 DM in Saudi Arabia are undiagnosed, which indicates the importance of early detection to understand the true burden of the disease. In addition, early detection and management of type 2 DM prevents complications related to diabetes. Also, identifying prediabetes cases helps prevent or delay the onset of type 2 DM. Methods: This study included both observational cross-sectional and longitudinal study designs. Schoolteachers in Riyadh were randomly selected from the Ministry of Education database and invited to complete the Saudi diabetes risk score questionnaire. Those identified as high risk underwent diabetes diagnostic tests, such as fasting plasma glucose and glycated haemoglobin (HbA1c), at collaborating primary healthcare centres. Participants diagnosed with type 2 DM or prediabetes were followed up after 3 months to assess risk factors associated with changes in HbA1c. Additionally, participants completed health-related quality of life (HRQoL) questionnaires at baseline, 3 months, and 6 months, to assess the quality of life of participants over time and compare HRQoL outcomes between low and high risk participants. Results: Among 945 recruited participants, 387 (41%) were female, the mean age was 42.5 years (SD ± 7.1), and 372 (39.4%) were classified as high risk. Out of 109 high risk participants who attended diabetes diagnostic testing, 7 (6.4%) were diagnosed with type 2 DM, and 19 (17.4%) were diagnosed with prediabetes. Population weighted estimates indicated that 1.8% of teachers in Riyadh had undiagnosed type 2 DM or prediabetes (95% CI: 0%, 6.91%). Among participants diagnosed with type 2 DM or prediabetes greater reductions in HbA1c levels at the 3-month follow-up was associated with higher baseline HbA1c levels (Coefficient: -0.63, 95% CI: [-0.79, -0.47]). Additionally, high risk participants reported lower HRQoL scores across physical, psychological, social relationships, and environment domains compared to low risk participants, with statistically significant differences observed in the physical (Coefficient: -5.57, 95% CI: [-8.65, -2.48]) and psychological (Coefficient: -4.40, 95% CI: [-7.47, -1.33]) domains. Conclusion: The study found a high prevalence of teachers at high risk of type 2 DM in Saudi Arabia. Early identification and intervention for participants with higher baseline HbA1c levels were associated with greater HbA1c reductions after 3 months, which may lead to better health outcomes and reduce the burden of diabetes-related complications. These findings highlight the feasibility and potential benefits of systematic prediabetes and type 2 DM case finding programmes in Saudi Arabia.22 0Item Restricted Economic Evaluations of Sickle Cell Disease-Modifying Therapies in Adult Patients(Howard University, 2024-07) Algatan, Razan; Wingate, La'Marcus T.Throughout history, sickle cell disease (SCD) has faced unequal healthcare treatment, impacting African Americans disproportionately due to difficulties in obtaining high-quality medical services. Although advancements in medicine have resulted in longer lifespans, these improvements may not fully meet the complex requirements of the growing number of elderly individuals dealing with the illness. Objectives: The objectives of this study are to (1) to investigate how the type of insurance influences the use of crizanlizumab and voxelotor in adult patients with SCD; (2) to evaluate the financial burden and therapeutic benefits of SCD therapies in mature individuals; and (3) to determine the financial impact and feasibility of using SCD treatments in U.S. Medicaid programs that have the highest rates of SCD. Methods: A comprehensive review of patient records was undertaken at the adult SCD clinic at Howard University Hospital, spanning from 2019 to 2023. The review focused on patients prescribed crizanlizumab and voxelotor, and extracted demographic data and insurance information. Logistic regression used to predict crizanlizumab or voxelotor usage A cost-utility analysis compared the cost-effectiveness of SCD-modifying therapies to automated red blood cell exchange in adult patients, using a lifetime horizon and taking into account societal costs. This model was then used to estimate the total budgetary impact of these therapies versus automated red blood cell exchange over a one-year period, from the perspective of U.S. Medicaid programs with the highest incidence of SCD, and exploring the potential benefits of an annuity payment model. Results: A total of 54 patients with were included, SCD, with an average age of 39.4 years, and the vast majority were single (90.7%). Notably, patients with dual eligibility had a significantly higher average age (43 years) compared to those with only Medicaid coverage(40 years). After controlling for other factors, the results showed that patients with Medicare coverage were nearly 10 times more likely to receive crizanlizumab compared to those with Medicaid coverage. The cost utility analysis indicated that automated red blood cell exchange (aRBCX) may be a cost-effective strategy compared to other SCD-modifying therapies, with a cost per quality-adjusted life-year (QALY) below $100,000, depending on the severity of SCD and the likelihood of death due to vaso-occlusive crisis. The cost-utility model predicted that hydroxyurea had the lowest lifetime costs, approximately $1,039,311, while voxelotor had the highest, approximately $3,252,674. Also, aRBCX resulted in the highest QALY and the fewest acute pain episodes over a lifetime. In terms of cost-effectiveness, l-glutamine had the lowest incremental cost-effectiveness ratio compared to aRBCX. Furthermore, the analysis demonstrated that voxelotor had the largest annualized budget impact, adding approximately $95,702.40 per patient compared to aRBCX, while hydroxyurea offered significant short-term cost savings of approximately $41,519.23 per patient relative to aRBCX. Conclusions: Medicaid serves as a vital safety net for individuals afflicted with SCD, with roughly half of adult sufferers relying on Medicaid or similar programs for their health insurance needs. Despite this, the adoption of interventions that can alter the course of SCD remains surprisingly limited. In stark contrast, aRBCX has consistently shown more favorable results in adult patients compared to these disease-modifying therapies.24 0Item Restricted Influence Of Home-Based Cardiac Rehabilitation On Health-Related Quality Of Life In Patients Post-Coronary Artery Bypass Graft: A Systematic Review(Saudi Digital Library, 2023) Alhamidah, Muhannad Ali; Holly SpencerQuality of Life (HRQoL) in Patients Post-Coronary Artery Bypass Graft (CABG). Study design: Systematic review (SR) with narrative synthesis. Background: CABG is a major surgery aimed at managing coronary artery disease symptoms. However, its complications can lead to a deterioration in patients’ Health- Related Quality of Life (HRQoL). Despite clinic-based Cardiac Rehabilitation (CR) being strongly recommended to help improve HRQoL, patient participation in and adherence to CR are poor. To help enhance participation, Home-Based Cardiac Rehabilitation (HBCR) has been proposed as an alternative delivery model. Although numerous SRs have investigated HBCR in various cardiovascular diseases, none have focused on its influence on the HRQoL of patients post-CABG, in spite of the substantial burden experienced by these patients on HRQoL compared to the other populations. This SR aimed to collect, critique and review the relevant literature regarding HBCR’s influence on HRQoL in patients post-CABG and compare it with usual care (UC) and centre- based CR (CBCR). Methodology: A comprehensive search of Medline, EMBASE, CENTRAL, CINAHL and Web of Science databases was performed between 1 January and 15 January 2023 and revealed eight trials that were assessed for methodological rigour by two independent reviewers. Results: Four randomised controlled trials and one quasi-experimental study with a total of 530 participants were included. All five trials demonstrated significant improvements with HBCR in the physical domains of HRQoL (p<0.01 to p<0.05), and the two trials that included a social domain found similar significant improvements (p < 0.05). Psychological domain scores were inconsistent; while two trials revealed significant improvements (p=0.001 to p<0.01), three trials did not (p>0.05). Compared with UC, HBCR in the three trials elicited significantly greater improvements in all domains (p=0.001 to p<0.05), though one trial did not find a significant difference in the psychological domain (p>0.05). There were no significant differences between HBCR and CBCR in the three trials that compared the two, with both treatments causing significant improvements in physical and social domains (p=0.001 to p<0.05) while not providing significant improvements in the psychological domain (p>0.05). One trial however reported significant improvements in phycological domains in both (p=0.001). Conclusion: There is consistent evidence of the positive influence of HBCR on both physical and social domains of HRQoL but conflicting results on its influence on the psychological domain. HBCR appears to be superior to UC in its influence on all domains of HRQoL and could be an alternative to CBCR when targeting the physical and social domains of HRQoL. However, neither HBCR nor CBCR had a clear influence on the psychological domain of HRQoL.23 0