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

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 Oral Semaglutide, the Recent Innovation in GLP-1 RAs Era;Consensus Report

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Journal of Diabetes Mellitus 2023年第2期13卷 222-238页

作者： Ali Alromaih Abdullah Alshamrani Bandar Alharbi Ibtissam Alharbi Turki Alharbi Samia Bokhari hussein elbadawi Mohammed Almehthel Abdulghani Alsaeed Khalid Alyahia Fatimah Alhowyan Marc Evans Roopa Mehta Emad Issak Saud Alsifri Medical Services Ministry of Defense Riyadh Saudi Arabia Khamis Mushait Military Hospotal Khamis Mushait Saudi Arabia Prince Sultan Military Hospital Riyadh Saudi Arabia King Fahad Armed Forces Hospital Jeddah Saudi Arabia My Clinic Medical Center Jeddah Saudi Arabia King Fahad Medical City Riyadh Saudi Arabia South Region Armed Forces Hospital Khamis Mushait Saudi Arabia University Hospital Llandough Cardiff United Kingdom Department of Endocrinology and Metabolism INCMNSZ Mexico City Mexico Asalam Medical Center Cairo Egypt Al Hada Armed Forces Hospital Taif Saudi Arabia

GLP-1 receptor agonists (GLP-1 RAs) are among the most successful medications for treating people with type 2 diabetes mellitus (T2DM), giving reasonable glycemic control with a low risk of hypoglycemia in those who have failed to control their condition with other oral anti-diabetic drugs (OADs). However, GLP-1RAs are underutilized—as time patients remained on their last oral treatment regimen with inadequate glycemic control prior to GLP-1RA initiation is on average of 19 month—despite evidence supporting their effectiveness, safety, and possible CV outcome advantages. With the new advances in GLP-1 RAs, the first oral form for the semaglutide molecule was developed with proven efficacy, safety, and patient preferences that may help pave the road for more utilization of this class. Therefore, we, a Saudi task force, gathered to develop an explicit, evidence-based consensus on oral semaglutide use in Saudi patients with diabetes. The panel recommends a GLP-1RA in those T2DM patients with or without or at high risk for ASCVD, HF, and/or CKD when there is a need to minimize weight gain or promote weight loss, or when there is a need to minimize hypoglycemia. Ensure that people with T2DM and ASCVD, HF, or CKD are treated appropriately with an SGLT-2i or GLP-1 RA. This approach should be initiated independent of background therapy, glycaemic control, or individualized treatment goals. Healthcare professionals should do their best to prevent clinical inertia in T2DM to help people with T2DM achieve better glycemic control and prevent or delay diabetes-related complications. The availability of oral forms of GLP-1RA medications could help combat this problem of clinical inertia to start GLP-1RA at the right time, as patients prefer oral to injectable forms. The availability of oral GLP-1RA can help in starting this class early and encourage healthcare professionals in prescribing it at the right time. Moreover, it can help those patients who fear of the injections. The p

关键词： Glucagon-Like Peptide-1 Receptor Agonists T2DM Glycemic Control Semaglutide Oral Semaglutide Injectable Semaglutide

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Saudi Consensus on the Usage of Sodium-Glucose Cotransporter-2 Inhibitors on the Management of Chronic Kidney Diseases

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International Journal of Clinical Medicine 2023年第12期14卷 525-539页

作者： Abdulrahman Alsheikh Ahmed Aljedai Hajer Almudaiheem Salwa Alaidarous Ali Alshehri hussein elbadawi Saeed Alghamdi Faisal Aljehani Sami Alobaidi Talal A. Altuwaijri Khalid Almatham David Strain Marc Evans Emad R. Issak Saud Alsifri King Abdulaziz University Hospital Jeddah Saudi Arabia Ministry of Health Riyadh Saudi Arabia Ministry of National Guards Hospital Jeddah Saudi Arabia King Fahad Medical City Riyadh Saudi Arabia My Clinic Jeddah Saudi Arabia College of Medicine University of Jeddah Jeddah Saudi Arabia College of Medicine King Saud University Riyadh Saudi Arabia College of Medicine Alfaisal University Riyadh Saudi Arabia University of Exeter Medical School Exeter UK University Hospital Llandough Cardiff UK College of Medicine Ain Shams University Cairo Egypt Alhada Armed Forces Hospital Taif Saudi Arabia

According to recent epidemiological data, chronic kidney diseases (CKDs) affect approximately 10% of the global population. Like many countries, CKD is a significant public health issue in Saudi Arabia. The prevalence of CKD in Saudi Arabia is estimated to be around 4.5% of the adult population, with a higher prevalence in older age groups. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are a class of oral medications used to treat type 2 diabetes mellitus (T2DM). In addition to their glucose-lowering effects, SGLT2i have been shown to have beneficial effects on kidney function in patients with or without T2DM. Therefore, a Saudi task force gathered to develop an explicit, evidence-based consensus on SGLT2i use in CKD Saudi patients. A panel of 14 experts made up a task force. An initial concept proposal was obtained. The proposal was divided into several topics discussed on 24 May 2023. A literature review was carried out. The literature search was completed on 3rd June 2023. A drafted report was distributed to the entire panel. Approval of the recommendations required consensus, defined as a majority approval (i.e. above 75%). The recommendations were revised to accommodate any differences of opinion until a consensus was reached. Recommendations were finally formulated on 21st June 2023. Subsequently, the panel reviewed and discussed the supporting rationale of the revised recommendations. This article presents these practical recommendations.

关键词： Chronic Kidney Disease Sodium-Glucose Cotransporter-2 Inhibitors Adverse Effects Monitoring Canagliflozin Dapagliflozin Empagliflozin

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Clinical Practice Guideline for the Management of Overweight and Obesity in Adults in Saudi Arabia

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International Journal of Clinical Medicine 2022年第12期13卷 590-649页

作者： Abdulrahman Alshaikh Ahmed Aljedai Assim Alfadda Abdulrahman Alrobayan Abdulwahab Bawahab Shaza Abou Ouf Ali Sultan Amani Alhozali Mohammed Bawazeer Eman Sheshah Fahad Alqahtani Hala Mosli hussein elbadawi Khaled Alamri Khalid Alshali Mohammed Aldawish Mohammed Alsofiani Raed Aldahash Rasha Alfawaz Reem Alamoudi Wessam Jamal Hajer Almudaiheem Emad R. Issak Saud Alsifri King Abdulaziz University Hospital Jeddah Saudi Arabia Ministry of Health Riyadh Saudi Arabia King Saud University Medical City Riyadh Saudi Arabia Prince Sultan Military Medical City Riyadh Saudi Arabia King Fahad General Hospital Jeddah Saudi Arabia International Medical Center Jeddah Saudi Arabia King Salman Hospital Riyadh Saudi Arabia King Fahad Medical Center Riyadh Saudi Arabia My Clinic Medical Center Jeddah Saudi Arabia King Abdulaziz Medical City Riyadh Saudi Arabia Saudi Centre for Disease Prevention and Control Riyadh Saudi Arabia Aslam Center Cairo Egypt Al Hada Armed Forces Hospital Taif Saudi Arabia

Obesity and overweight are prevalent in Saudi Arabia (24.95% & 31.80%). Also, childhood obesity in the country is a challenge, with 6% - 10% of preschool and school-age children. The burden of being overweight and obese is disastrous. Therefore, the Saudi Diabetes Scientific Society constituted a team to develop a guideline. The team reviewed the local Clinical Practice Guidelines for the Prevention and Management of Obesity in Saudi Arabia;and conducted a rigorous review of relevant evidence-based scientific literature. After a thorough assessment, a consensus was reached to use the Australian guideline as the main guideline to be adapted and localized to be suitable for the Saudi people. To avoid duplication of efforts, the team adopted the grading of evidence used by the Australian guideline. The updated version was presented in a workshop, and the recommendation of the participants was included. The final draft was distributed for review, and comments were included. This document presents the result of such an effort as a local guideline.

关键词： Obesity Overweight Disease Burden Management Guideline Saudi Arabia

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