Papers by Mohamed Hassanein
International Journal of Clinical Practice, Sep 1, 2016
Aims: Patients with type 2 diabetes mellitus (T2DM) have increased risk of adverse events (AEs; e... more Aims: Patients with type 2 diabetes mellitus (T2DM) have increased risk of adverse events (AEs; e.g. dehydration, hypoglycaemia) in hot weather. This analysis assessed the efficacy and safety of canagliflozin, a sodium glucose co-transporter 2 (SGLT2) inhibitor, in patients with T2DM who live in hot climates. Methods: This post hoc analysis evaluated patients with T2DM using pooled data from four 26-week, placebo-controlled studies (N=2,313) and data from a 104-week, active-controlled study (add-on to metformin vs glimepiride; N=1,450). Changes in HbA1c, fasting plasma glucose (FPG), body weight and blood pressure (BP) were assessed in subsets of patients living in hot climates (pooled, placebo-controlled studies, n=611; active-controlled study, n=307) and those living in other climates (i.e. other climate subset; pooled, placebo-controlled studies, n=1,702; active-controlled study, n=1,143). Safety was assessed based on AE reports. Results: Canagliflozin 100 and 300 mg lowered HbA1c, FPG, body weight and BP vs placebo over 26 weeks and glimepiride over 104 weeks in the hot climate subsets. Canagliflozin was generally well tolerated in the hot climate subsets, with a higher incidence of AEs related to the mechanism of SGLT2 inhibition (i.e. genital mycotic infections). Volume depletion-related AEs were low across groups. Conclusion: Canagliflozin improved glycaemic control, lowered body weight and BP, and was generally well tolerated in patients with T2DM living in hot climates compared with placebo over 26 weeks or glimepiride over 104 weeks.
Advances in Therapy
Type 2 diabetes mellitus (T2DM) and hypertension are leading risk factors for death and disabilit... more Type 2 diabetes mellitus (T2DM) and hypertension are leading risk factors for death and disability in the Middle East. Both conditions are highly prevalent, underdiagnosed and poorly controlled, highlighting an urgent need for a roadmap to overcome the barriers to optimal glycaemic and blood pressure management in this region. This review provides a summary of the Evidence in Diabetes and Hypertension Summit (EVIDENT) held in September 2022, which discussed current treat
Journal of Diabetes and Endocrine Practice
The 58th European Association for the Study of Diabetes (EASD) Annual Meeting was held between 19... more The 58th European Association for the Study of Diabetes (EASD) Annual Meeting was held between 19 and 23 September 2022 in Stockholm, Sweden. It was also fully streamlined online. The authors attended the conference, giving a narrative commentary on what they felt were the highlights of the meeting. Several interesting lectures were presented. The ADA-EASD hyperglycemia management consensus was among the landmark presentations. The development of a particular model that could predict severe hypoglycemia risk in people with type 2 diabetes (T2D) was interesting. The remission of T2D data from the ReTUNE analysis backs the “personal fat threshold” concept was very promising. Interestingly, a link between autoimmunity degree and latent autoimmune diabetes in adults' cardiovascular disease (CVD) risk was proposed. A benefit of high-intensity exercise for people with impaired hypoglycemia awareness was demonstrated. The CLOuD, namely, early and sustained closed-loop therapy does not ...
Dubai Diabetes and Endocrinology Journal
Introduction: A novel clinical calculator was developed to assist physicians in classifying the r... more Introduction: A novel clinical calculator was developed to assist physicians in classifying the risk for individuals with diabetes planning to observe fasting during the holy month of Ramadan. The aim of this study was to evaluate the necessity to use this approach. Methods: A survey with twenty-six clinical scenario questions was developed. All cases were pre-scored using the proposed Diabetes and Ramadan Risk Calculator. The survey was sent to 350 reputable practicing physicians with considerable expertise in managing patients with diabetes. The survey sought expert opinion on patients’ risk classification during Ramadan fasting. Quantitative methods were used for data analysis. Results: Responses of 312 participants were valid for analysis. There was a wide variation in evaluating patients’ risk, particularly in moderate-risk cases. Overall, responses to case scenarios were classified correctly with 33–85% variation in correct response. Geographical and inter-specialty difference...
Dubai Diabetes and Endocrinology Journal
Background: Injectable glucagon-like peptide-1 receptor agonists (GLP-1RAs) are proven to be well... more Background: Injectable glucagon-like peptide-1 receptor agonists (GLP-1RAs) are proven to be well tolerated and efficacious in people with type 2 diabetes mellitus (T2DM) fasting during Ramadan. The first oral GLP-1RA semaglutide, also indicated for the treatment of T2DM, has specific dosing instructions to optimize treatment exposure, which may need to be altered during Ramadan fasting to ensure optimal efficacy. Summary: Given the lack of current published evidence for the effect of oral semaglutide during Ramadan, a panel of experts formulated recommendations for the administration of oral semaglutide during Ramadan. Key Messages: This statement reports recommendations for oral semaglutide administration during Ramadan.
Diabetes Therapy
Cardiovascular disease (CVD) is a leading cause of death globally, driven by the high rates of ri... more Cardiovascular disease (CVD) is a leading cause of death globally, driven by the high rates of risk factors, such as diabetes and hypertension. As the prevalence of these risk factors is particularly high in the Gulf region, better diagnosis and management of type 2 diabetes (T2D) and hypertension has the potential to dramatically reduce adverse cardiovascular outcomes for individuals in that part of the world. This article provides a summary of presentations made during the EVIDENT summit, a virtual symposium on Evidence in Diabetes and Hypertension, held in September 2021, including a review of the various guidelines for both T2D and hypertension, as well as recent findings
Journal of Diabetes
The upsurge of type 2 diabetes mellitus is a major public health concern in the Middle East and N... more The upsurge of type 2 diabetes mellitus is a major public health concern in the Middle East and North Africa (MENA) and Africa (AFR) region, with cardiorenal complications (CRCs) being the predominant cause of premature morbidity and mortality. High prevalence of cardiometabolic risk factors, lack of awareness among patients and physicians, deficient infrastructure, and economic constraints lead to a cascade of CRCs at a significantly earlier age in MENA and AFR. In this review, we present consensus recommendations by experts in MENA and AFR, highlighting region-specific challenges and potential solutions for management of CRCs. Health professionals who understand sociocultural barriers can significantly increase patient awareness and encourage health-seeking behavior through simple educational tools. Increasing physician knowledge on early identification of CRCs and personalized treatment based on risk stratification, alongside optimum glycemic control, can mitigate therapeutic inertia. Early diagnosis of high-risk people with regular and systematic monitoring of cardiorenal parameters, development of region-specific care pathways for timely referral to specialists, followed by guideline-recommended care with novel antidiabetics are imperative. Adherence to guideline-recommended care can catalyze utilization of sodium glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists with demonstrated cardiorenal benefits-thus paving the way for overcoming care gaps in a cost-effective manner. Leveraging digital technology like electronic medical records can help generate real-world data and provide insights on voids in adoption of newer antidiabetic medications. A patient-centric approach, collaborative care among physicians from different specialties, alongside involvement of policy makers are key for improving patient outcomes and quality of care in MENA and AFR.
Diabetes Therapy, 2022
Introduction: In this ORION study subgroup analysis, the safety and effectiveness of insulin glar... more Introduction: In this ORION study subgroup analysis, the safety and effectiveness of insulin glargine 300 U/mL (Gla-300) was evaluated in people from the South Asia region with type 2 diabetes mellitus (T2DM) before, during, and after Ramadan, in a real-world setting. Methods: The ORION study was a real-world, prospective, observational, non-comparative study conducted across 11 countries. The current subgroup analysis included participants from the South Asia region (India and Pakistan) who fasted during Ramadan. The primary endpoint was the percentage of participants experiencing C 1 event of severe and/or symptomatic documented hypoglycemia with selfmonitored plasma glucose (SMPG) B 70 mg/dL during Ramadan. Secondary endpoints analyzed were changes in glycated hemoglobin
Diabetes Research and Clinical Practice, 2022
Fasting during Ramadan is one of the five pillars of Islam and is obligatory for all healthy Musl... more Fasting during Ramadan is one of the five pillars of Islam and is obligatory for all healthy Muslims from the age of puberty. Though individuals with some illness and serious medical conditions, including some people with diabetes, can be exempted from fasting, many will fast anyway. It is of paramount importance that people with diabetes that fast are given the appropriate guidance and receive proper care. The International Diabetes Federation (IDF) and Diabetes and Ramadan (DaR) International Alliance have come together to provide a substantial update to the previous guidelines. This update includes key information on fasting during Ramadan with type 1 diabetes, the management of diabetes in people of elderly ages and pregnant women, the effects of Ramadan on one's mental wellbeing, changes to the risk of macrovascular and microvascular complications, and areas of future research. The IDF-DAR Diabetes and Ramadan Practical Guidelines 2021 seek to improve upon the awareness, knowledge and management of diabetes during Ramadan, and to provide real-world recommendations to health professionals and the people with diabetes who choose to fast.
Journal of the Endocrine Society, 2021
Background: People with type 2 diabetes (T2D) are at an increased risk of severe hypoglycaemia wh... more Background: People with type 2 diabetes (T2D) are at an increased risk of severe hypoglycaemia when fasting. SOLIRAM is an international, prospective, observational study evaluating the safety and effectiveness of the fixed-ratio combination (FRC) of insulin glargine 100 U/mL and lixisenatide (iGlarLixi) in people with T2D who fast during Ramadan. Methods: SOLIRAM will be performed in two waves. Here, we present the interim results, using descriptive statistics, from participants who fasted during Ramadan in 2020 (Wave 1). Adults with T2D who had taken iGlarLixi for ≥3 months before inclusion and who planned to fast for ≥15 days during Ramadan, were enrolled from 5 countries. During the study, iGlarLixi treatment was adjusted as per routine practice by the treating physician. Results: Overall, 155 people with T2D (54.2% male) were eligible. Mean±SD age was 58.4±9.5 years, body mass index was 30.5±6.0 kg/m² and 64.5% of people had ≥1 diabetes-related complications. Proportion of pati...
Journal of Fasting And Health, 2016
Ramadan fasting has been a major concern among researchers considering the theoretically imposed ... more Ramadan fasting has been a major concern among researchers considering the theoretically imposed risk on patients with diabetes mellitus due to prolonged fasting. Studies indicate that the knowledge and practices of physicians do not comply with the proposed recommendations in this regard in many cases. This study aimed to explore the viewpoints and attitudes of physicians toward the management of diabetes mellitus regarding to Ramadan fasting. In addition, we assessed the knowledge and compliance of physicians with available recommendations regarding the management of diabetes mellitus in Ramadan. According to the results, Ninety five present of the physicians (n=862) believed the type of diabetes to be “important” or “very important” in decision-making for Ramadan fasting. Control of diabetes before Ramadan was noted as “important” or “very important” by 95 of the physicians (n=848). Moreover, the majority of respondents emphasized on the pivotal role of self-monitoring of blood g...
Dubai Diabetes and Endocrinology Journal, 2020
Background: The health and social burdens of diabetes mellitus (DM) are steadily increasing world... more Background: The health and social burdens of diabetes mellitus (DM) are steadily increasing worldwide, reflecting the impact of urbanization, industrial transitions, and shifting to nonhealthy, sedentary life patterns’, as well as the high sugar, low-fiber food consumptions. All these factors have contributed to the global increase in the prevalence of DM and metabolic disorders. Objectives: The objective is to study the prevalence of DM among adult cohorts in Dubai and the extent of behavioral health risk factors associations. Methodology: A cross-sectional household health survey with multistage, stratified cluster random sample of 9,630 participants including 2,496 households was carried out in Dubai 2019. About 5,371 non-United Arab Emirates (UAE) national, 2,245 UAE-nationals, of different age-groups, gender, education, nationality, smoking, and marital status were included in the survey. The survey questionnaire was adapted from the one used in the World Bank’s Living Standard...
Diabetic Medicine, 2020
Abbott and Merck Sharp & Dohme. KK and WH are Trustees and Co-Chairs of the Diabetes working grou... more Abbott and Merck Sharp & Dohme. KK and WH are Trustees and Co-Chairs of the Diabetes working group of the charity South Asian Health Foundation. Novelty Statement Guidelines about managing diabetes during Ramadan have been published by various societies, including the latest one from the South Asian Health Foundation UK. The COVID-19 pandemic poses new challenges for managing people with diabetes who choose to fast during Ramadan. These guidelines address these challenges and give the most up to date advice based on current evidence, to help those who choose to fast do so safely.
Diabetes Research and Clinical Practice, 2020
on behalf of the DIA-RAMADAN study investigators, A real-world study in patients with type 2 diab... more on behalf of the DIA-RAMADAN study investigators, A real-world study in patients with type 2 diabetes mellitus treated with gliclazide modified-release during fasting: DIA-RAMADAN,
Advances in Therapy, 2020
Introduction: To describe the characteristics and care of participants with type 1 diabetes durin... more Introduction: To describe the characteristics and care of participants with type 1 diabetes during Ramadan in the Middle East and North Africa. Methods: The DAR-MENA (Diabetes and Ramadan-Middle East and North Africa) study was a prospective, observational study of adults with type 1 and type 2 diabetes who were Muslim and did/did not intend to fast during Ramadan 2016. Baseline data were collected 6 weeks prior to Ramadan, with a follow-up visit 1-2 months after Ramadan. This is the analysis of the population with type 1 diabetes. Measurements included proportion who fasted, reasons for fasting and not fasting, changes in diabetes treatment, hypoglycemic events, and proportion with access to diabetes education. Results: Of 136 participants with type 1 diabetes, 76.9% (100/130) fasted for at least 1 day, 72.3% (94/130) fasted for at least 15 days, and 48.5% (63/130) fasted for 30 days. The majority (63.0%, 63/100) reported personal decision as a reason to fast. Fear of diabetic complications (58.6%, 17/29) and previous complications related to fasting Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.11860932.
British Journal of Nutrition, 2019
Studies on the impact of Ramadan diurnal intermittent fasting (RDIF) on the metabolic syndrome (M... more Studies on the impact of Ramadan diurnal intermittent fasting (RDIF) on the metabolic syndrome (MetS) components among healthy Muslims observing Ramadan month have yielded contradictory results. This comprehensive meta-analysis aimed to obtain a more stable estimate of the effect size of fasting during Ramadan on the MetS components, examine variability among studies, assess the generalisability of reported results and perform subgroup analyses for associated factors. We searched the CINAHL, Cochrane, EBSCOhost, Google Scholar, ProQuest Medical, PubMed/MEDLINE, ScienceDirect, Scopus and Web of Science databases for relevant studies published from 1950 to March 2019. The MetS components analysed were: waist circumference (WC), systolic blood pressure (SBP), fasting plasma/serum glucose (FG), TAG, and HDL-cholesterol. We identified eighty-five studies (4326 participants in total) that were conducted in twenty-three countries between 1982 and 2019. RDIF-induced effect sizes for the Met...
Diabetes Research and Clinical Practice, 2019
Objectives: To describe the risk of hypoglycaemia during Ramadan and determine its risk factors, ... more Objectives: To describe the risk of hypoglycaemia during Ramadan and determine its risk factors, and the impact of hypoglycaemia on patients' behaviour. Methods: A cross-sectional multi-country observational study, with data captured within 6 weeks after Ramadan 2015. Patients' and disease characteristics and its management, the risk of hypoglycaemia and patients' response to hypoglycaemia were recordedresults A cohort of 1759 patients; majority with type 2 diabetes mellitus from North Africa, Arabian Gulf, Saudi Arabia, and the Indian subcontinent. Hypoglycaemia was reported by 290 patients (16.8%); particularly affecting type 1 diabetes patients and in insulin-treated patients in general. Age was significantly younger in the hypoglycaemia group (P<0.001). The commonest responses were reducing the dose or frequency of medications (42%), attending primary care providers (24.5%) or increasing monitoring (20.7%). Fasting was interrupted by 67% only of those who experienced hypoglycaemia and recourse to emergency services was pursued by less than a quarter of patients with hypoglycaemia. The country-wise analysis of the rates of hypoglycaemia was greatest in Egypt (51.3%) and lowest in Pakistan (3.5%). Conclusions: Hypoglycaemia is a significant complication of fasting during Ramadan. It may be predicted by type of diabetes, and use of insulin. Patients' responses are varied and call for more formal pre-Ramadan education.
Journal of Diabetes & Metabolism, 2016
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Papers by Mohamed Hassanein
glucometabolic markers have yielded conflicting results. We conducted a meta-
analysis to estimate the effect size for changes in glucometabolic markers in healthy,
non-athletic Muslims during Ramadan, and to assess the effect of variable covariates
using meta-regression.
Methods: CINAHL, Cochrane, EBSCOhost, EMBASE, Google Scholar, ProQuest
Medical, PubMed/MEDLINE, ScienceDirect, Scopus, and Web of Science databases
were searched from date of inception to January 2020. The glucometabolic markers
analyzed were fasting glucose (FG), insulin, insulin resistance (HOMA-IR), leptin,
and adiponectin.
Results: We identified seventy-two studies (3134 participants in total) that were
conducted in 22 countries between 1982 to 2020. RDIF-induced effect sizes for the
glucometabolic markers were FG (no. of studies K=61, number of subjects N=2743,
Hedges' g = -0.102, 95% CI: -0.194, -0.01); serum insulin (K=16, N= 648,
Hedges' g =0.030 95% CI: -0.165, 0.226); HOMA-IR (K=10, N=349, Hedges' g = -
0.012, 95% CI: -0.274, 0.250); leptin (K=13, N=442, Hedges' g = -0.010, 95% CI: -
0.243, 0.223); and adiponectin (K=11, N=511, Hedges' g =0.034, 95% CI: -0.227,
0.296).
Conclusion: RDIF imposes no adverse metabolic impacts, and might help in
improving some glucometabolic markers in healthy subjects.