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Clinical Practice Recommendations for Assessment and Management of Hypothyroidism

International Journal of Clinical Medicine 2022年第12期13卷 650-678页

作者： Saud Alsifri Nasser Aljuhani Ahmed Aljedai Tariq Nasser fahad alsabaan Hajer Almudaiheem Ashraf Amir Ebtissam Baissa Nadia Ghannam Mohammed Aldawish Afaf Alshammari Emad R. Issak Alhada Armed Forces Hospital Taif Saudi Arabia East Jeddah Hospital Jeddah Saudi Arabia Ministry of Health Riyadh Saudi Arabia Ministry of National Guards Hospital Jeddah Saudi Arabia Security Forces Hospital Riyadh Saudi Arabia International Medical Center Jeddah Saudi Arabia Alrawdaha General Hospital Dammam Saudi Arabia First Clinics Jeddah Saudi Arabia Prince Sultan Military Hospital Riyadh Saudi Arabia Aslam Center Cairo Egypt

Hypothyroidism is a common disorder, potentially severe, often clinically ignored, easily diagnosed by laboratory tests, and highly treatable. It may cause chronic illnesses if left untreated. Saudi Society of Endocrinology and Metabolism (SSEM) assembled a panel of twelve endocrinologists with experience in thyroid diseases in adults and children and made up a task force. An initial concept proposal that included types of hypothyroidism, population, scope, and prevalence in Saudi Arabia was obtained. The proposal was divided into several topics discussed in February 2022. The panel approved that the consensus will include all types of hypothyroidism in Saudi Arabia, screening, diagnosis, management, and special population. A literature review was carried out. Most of the latest international guidelines were screened in Europe and USA. The literature search was completed in March 2022. They drafted a report that was distributed to the entire panel. Approval of the recommendations required consensus, defined as a majority approval. The recommendations were revised to accommodate any differences of opinion until a consensus was reached. Recommendations were finally formulated on April 2022. Subsequently, the panel reviewed and discussed the supporting rationale of the revised recommendations. This article presents these practical recommendations.

关键词： Hypothyroidism Screening Diagnosis Management

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Saudi Consensus for GLP-1 RAs Switching Guidance: Consensus Report

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International Journal of Clinical Medicine 2022年第1期13卷 22-35页

作者： Saud Alsifri Hussein Elbadawi fahad alsabaan Abdulraouf Almahfouz Khalid Alyahya Eman Shesha Laila Abu Esba Meshal Alnais Raed Aldahash Turky Alharbi Saleh Aljaser Emad R. Issak Endocrinology Department Alhada & Taif Armed Forces Hospitals Taif Saudi Arabia My Clinic Medical Center Jeddah Saudi Arabia Endocrinology Department Security Forces Hospital Riyadh Saudi Arabia Section of Endocrinology Department of Medicine The King Faisal Specialist Hospital and Research Centre Riyadh Saudi Arabia Pharmacy Department Prince Sultan Military Medical City Riyadh Saudi Arabia Diabetes Center King Salman Hospital Riyadh Saudi Arabia King Abdulaziz Medical City Riyadh Saudi Arabia Internal Medicine and Diabetes King Khalid Hospital Hail Saudi Arabia Department of Medicine King Abdulaziz Medical City National Guard Riyadh Saudi Arabia Family Medicine Department Prince Sultan Military Medical City Riyadh Saudi Arabia King Saud bin Abdulaziz University for Health Science Riyadh Saudi Arabia Medicine Department Faculty of Medicine Ain-Shams University Cairo Egypt

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) provide adequate glycemic control, weight reduction, low risk of hypoglycemia, and CV risk reduction. Their usage for type 2 DM (T2DM) is recommended mainly when hypoglycemia or weight gain should be considered, also, whenever initial therapy is failed. There are many recent updates in the treatment paradigm of T2DM. There are many types of GLP-1RAs, with a knowledge gap regarding switching between the different types. A Saudi task force gathered to develop an explicit, evidence-based consensus for switching between GLP-1RAs, when, why, and how? This article contains the expert panel’s recommendations as a contribution to complement the knowledge gap in this area from the national perspective. As an alternative to intensifying therapy, switching from one GLP-1RA to another has various advantages. Improvements in glycemic control, weight loss, adherence, and medications with established cardiovascular benefits are among them. Also, switching needs to be individualized upon many discussed factors like the dose of the previous GLP1-RA and gastrointestinal adverse effects. Discussion with patients about the why and how to switch is critical.

关键词： Glucagon-Like Peptide-1 Receptor Agonists Switching Type 2 DM Glycemic Control

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Saudi Consensus for Low-Premixed Insulin Analogues in Type 2 Diabetes: Consensus Report

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International Journal of Clinical Medicine 2021年第4期12卷 165-182页

作者： Abdulrahman Alshaikh Mohammed Aljamal Saud Alsifri Ali Alrumaih Samia Bokhari Mohammed Almuzaini Khalid Alyahya Abdulaziz Bin Shaikh Turky Alharbi Rashid Aljuwair fahad alsabaan Emad R. Issak Medicine Department College of Medicine King Abdulaziz University Jeddah KSA Supply Chain Department King Fahd Armed Forces Hospital Jeddah KSA Endocrinology Department Alhada & Taif Armed Forces Hospitals Taif KSA Endocrinology Department King Fahad Armed Forces Hospital Jeddah KSA Pharmacy Department Prince Sultan Military Medical City Riyadh KSA Family Medicine Department Prince Sultan military Medical City Riyadh KSA Endocrinology Department Dahran Medical Complex Dahran KSA Endocrinology Department Security Forces Hospital Riyadh KSA Medicine Department Faculty of Medicine Ain-Shams University Cairo Egypt

Dear Dr. Martin Hovland, We learned from the literature that premixed insulins are short-acting insulin or rapid-acting insulin analogue mixed with intermediate-acting insulin in a fixed ratio, addressing FBG and PPBG in one injection. There are two categories;high-mix and low-mix premixed insulins. We, a Saudi task force, gathered to develop an explicit, evidence-based consensus for the use of the low-mix premixed insulin for better glycemic control. The treatment with premixed aspart 30 was non-inferior to treatment with premixed insulin lispro 25. In addition, Self-monitored blood glucose levels were comparable. Safety profiles were similar between both treatments, as was the incidence of hypoglycemic episodes. The switch between both products of the low-mix family can be carried out without any problem. Both products of the low-mix premixed insulin analogues aspart 30/70 and premixed insulin lispro 25/75 have comparable efficacy and safety as shown from the medical literature. Therefore, we can change from one to another safely as demonstrated by the US FDA statement. In addition, the ergonomic features of KwikPen’s design and function may offer important advantages for the user during insulin administration.

关键词： Low-Mix Premixed Insulin Lispro 25/75 Aspart 30/70

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