Introduction and Objective: Physical activity intensity may differentially influence body composition and skeletal health in people with type 1 diabetes (T1D). The aim of the current study was to examine the associations of objectively measured light, moderate, and vigorous physical activity with body composition and bone parameters. Methods: This cross-sectional analysis included 273 people with T1D (54.2% males, 45.8% females). Physical activity was assessed using a wrist-worn accelerometer over 7 consecutive days. Multivariable linear regression models adjusted for age, sex, and body mass index (BMI) were used to examine associations of light, moderate, and vigorous physical activity with total tissue fat, total fat mass, total lean mass, relative skeletal muscle index (RSMI). bone mineral content (BMC) and total bone mineral density (BMD). Results: Light physical activity was associated with lower total tissue fat (β-coefficient [95% CI] 2.22 [−4.28, −0.15], p=0.035) and total fat mass (−0.002 [−0.003, -0.00004], p=0.045). Moderate physical activity showed similar inverse associations with total tissue fat (−1.38 [−2.35, −0.41], p=0.005) and total fat mass (−0.001 [−0.002, -0.0004], p=0.003). Vigorous activity was also strongly associated with lower total tissue fat (−0.20 [-0.29, -0.11], p<0.001) and total fat mass (−0.0001, [-0.0002, -0.00005], p= 0.001). Light and moderate intensity physical activity were not associated with lean mass, BMD or BMC. In contrast, vigorous physical activity was positively associated with total total lean mass (0.0001 [0.00002, 0.0002], p= 0.015), RSMI (0.40 [0.10, 0.70], p= 0.008), BMD (4.99 [1.33, 8.65], p= 0.008) and BMC (0.001 [0.0001, 0.003], p=0.042). Conclusion: In people with T1D, all intensities of physical activity appear beneficial for adiposity, whereas only vigorous physical activity is beneficial for lean mass and bone health. These findings underscore the importance of physical activity intensity in optimizing musculoskeletal and body composition outcomes in people with T1D. Disclosure J. AlKandari: None. M. Irshad: None. S. Mourad: None. D. Alsaeed: None. A. Al-Ozairi: None. A.S. Mashankar: None. S.R. Gray: None. E. Alozairi: None. Funding The manpower used in this study has been funded by the Kuwait Foundation of Advancement of Science (KFAS) and the Ministry of Health, Kuwait.

Purpose:This study aimed to investigate the association of timing of the most active five hours (M5 time) with markers of cardiometabolic health in people with type 1 diabetes (T1D) and type 2 diabetes (T2D). Patients and Methods:People with T1D or T2D were invited to participate in the study. Physical activity was measured over a 7-day period with a wrist worn accelerometer. The M5time (as a linear and circular (sin-cos) variable) and the amount of activity in these five hours (M5value) were calculated, and associations with glycaemic control, blood lipids and body composition were examined using multiple linear regression, with multiple testing controlled using false discovery rate (FDR) correction. Results:A total of 891 people with T1D and 1381 people with T2D were included. In people with T1D, M5time (linear) was associated with waist circumference after full adjustment (model 3) (B = -0.32, SE = 0.15, FRD p = 0.047). Similarly, in people with T1D M5 time (circular) was also significantly associated with BMI (p = 0.004) and waist circumference (p = 0.001), with amplitudes of BMI: 1.32 kg/m2 and Waist: 4.28 cm, and phases of BMI: 12:51h and Waist: 13:06h. In people with T2D, M5 time was not associated with any cardiometabolic markers after FDR correction in any adjusted models. Conclusion:In people with T1D, the time of day at which people were most active was associated with some cardiometabolic markers. However, in people with T2D, there was no association with any cardiometabolic markers. Overall, our data indicates little effect of time of and physical activity at any time of day should be promoted.

Introduction Medication for the disease of obesity has improved, and clinical trials based on natural gut hormones such as tirzepatide, showed only mild side effects and ~22% weight loss maintenance. However, patients with type 2 diabetes only lose 15% bodyweight with tirzepatide while tolerating the medications very well, but little is known in patients with the disease of obesity who also have type 1 diabetes, especially regarding safety of the medications. Tirzepatide’s licence in the Gulf countries and Europe for obesity does not exclude patients with obesity and type 1 diabetes, unlike the USA. In Kuwait, more than a quarter of patients with type 1 diabetes also have the disease of obesity. Tirzepatide is not approved for glycaemic control in patients with type 1 diabetes, because it is unlikely to make a difference. Because tirzepatide is approved for the treatment of obesity in patients who also have type 1 diabetes we can now test how effective treatments for obesity such as tirzepatide are for patients with obesity and type 1 diabetes. Concerns regarding the safety of the medication in type 1 diabetes can also be addressed thus addressing an important knowledge gap.Methods and analysis This will be a randomised double blind controlled trial of 60 patients with obesity and type 1 diabetes to test usual care with or without maximum tolerable dose of tirzepatide to achieve weight loss. We will investigate the safety of the medications in patients with obesity and type 1 diabetes to address important knowledge gap which can change clinical practice.Ethics and dissemination The study has received ethical approval from the Dasman Diabetes Institute Ethical Review Committee (HR-RA-2025-03) and is registered at ClinicalTrials.gov (NCT07096908). Written informed consent will be obtained from all participants, with no financial compensation provided. Data will be reported in accordance with Consolidated Standards of Reporting Trials guidelines, ensuring participant anonymity. Findings will be disseminated through peer-reviewed publications and presentations at national and international conferences.Trial registration number NCT07096908.

BackgroundGlobally, many patients with Type 1 diabetes (T1D) are now characterized by excess adipose tissue and features of insulin resistance. In Kuwait, rapid urbanization, shifts in dietary patterns, and decreased physical activity have contributed to rising obesity prevalence in the general population.ObjectivesWe aimed to investigate the interplay between the diseases of obesity and T1D, examining patients' perspectives on why they gained body weight, psychological aspects, and management challenges.MethodsA mixed-methods approach was employed, encompassing quantitative analysis of body mass index (BMI) and lifestyle factors among 51 participants with T1D and obesity or obesity-related complications and a thematic analysis of perceptions and experiences related to obesity and T1D using an online survey.ResultsParticipants identified lifestyle factors as the primary contributors to obesity, emphasizing the need for holistic interventions. About 56.8% of the participants perceived T1D as a barrier to obesity treatment. The qualitative analysis revealed four themes: 1) negative perceptions about obesity, 2) poor interface with healthcare professionals (HCPs), 3) lack of suggestions for improving obesity management, and 4) poor self-image and awareness. This provided in-depth insights into participants' perceptions, worries, experiences, and suggestions for managing obesity in the context of T1D.ConclusionsThis study contributes a nuanced understanding of obesity in patients with T1D, shedding light on the complexities beyond glycemic control. The findings emphasize the need for patient-centered, multidisciplinary approaches that consider both medical and psychological aspects in the management of obesity within patients with T1D.

Purpose: The aim of this cross-sectional study was to compare the Arabic version of International Physical Activity Questionnaire (IPAQ) measured moderate-to-vigorous physical activity (MVPA) with accelerometer-measured MVPA in people with diabetes. Methods: From 2020 to 2022 physical activity was measured people >= 18 years with type 1 or type 2 diabetes in Kuwait. Self-reported MVPA was measured over 7 days with the Arabic version of the IPAQ. During the same 7-day period wrist worn accelerometers were used to objectively measure MVPA. IPAQ MVPA was calculated both including and excluding walking physical activity. MVPA measures were compared by limits of agreement approach, Pearson correlations and concordance correlations. Results: We recruited 240 participants with type 1 diabetes and 343 participants with type 2 diabetes for the study. In people with type 1 diabetes, there were no concordance correlations between IPAQ MVPA, both including (rho = - 0.011 (- 0.038, 0.017), p = 0.444) and excluding (rho = - 0.001 (- 0.067, 0.065), p = 0.978) walking physical activity. MVPA measured by IPAQ was 43.3(- 85.6, 172.2) min/day higher than accelerometer-measured MVPA, when including walking, and 8.88(- 60.4, 78.2) min/day higher, when excluding walking. In people with type 2 diabetes, there were significant positive concordance correlations between IPAQ MVPA, both including (rho = 0.038 (0.02, 0.06), p < 0.001) and excluding (rho = 0.34 (0.27, 0.41), p < 0.001) walking physical activity. MVPA measured by IPAQ was 62.3 (95% CI - 61.5 to 186.0) min/day higher than accelerometer-measured MVPA, when including walking, and 4.0 (95% CI - 34.1 to 42.0) min/day higher, when excluding walking. Conclusion: In people with type 1 or type 2 diabetes, caution should be exercised when using the Arabic version of the IPAQ to measure MVPA.

Introduction & Objective: To investigate the association of the timing and magnitude of peak physical activity with cardiometabolic outcomes, such as glycated haemaglobin (HbA1c) and body mass index (BMI), in people with type 1 and type 2 diabetes. Methods: We recruited 810 people with type 1 diabetes and 1381 people with type 2 diabetes to the study. Participants wore a wrist-worn accelerometer for a 7 day and the start time of the most active 5 hours (M5time) and the acceleration (physical activity) performed in this 5 hour period (M5value) quantified. Outcome variables recorded were HbA1c, total cholesterol, HDL cholesterol, LDL cholesterol, waist circumference and BMI. Associations were assessed by linear regression after adjustment for sex, age and total (24 hour) physical activity levels. Results: In people with type 1 diabetes the M5 time was no associated with any of the outcome variables, but the M5value was associated with HbA1c (β-coefficient [95%CI], -0.19[-0.05,-0.32], p-value 0.005), HDL cholesterol (0.004,[0.001,0.007], p-value 0.016) and LDL cholesterol (-0.008[-0.001,-0.016], p-value 0.034). In people with type 2 diabetes both the M5time 0.45[0.05,0.85], p-value 0.028) and M5value (-0.23[-0.03,-0.43], p-value 0.032) were associated with HbA1c. No other associations were observed. Conclusions: A greater amount of physical activity during the peak activity time was associated with better glycaemic control in people with type 1 and 2 diabetes, even after adjusting for total physical activity levels. Performing peak physical activity levels earlier in the day was also associated with better glycaemic control, only in people with type 2 diabetes. Disclosure E.S. Alozairi: None. J. AlKandari: None. D. Alsaeed: None. M. Irshad: None. B.C. Alesmaeel: None. M. Abdalla: None. M.A. Abdullah: None. S.R. Gray: None. Funding Kuwait Foundation for the Advancement of Sciences (KFAS), Kuwait

OBJECTIVE:Obesity-related problems can now be managed with effective nutritional therapy, pharmacotherapy, and surgeries that achieve >10% weight loss. Assessing patient preferences, treatment choices, and factors affecting patients can improve treatment compliance and efficacy. Our aim was to identify factors affecting patient preference and subsequent choice of pharmacotherapy among those seeking treatment for obesity-related disorders. METHODS:A participatory action study using purposeful sampling recruited 33 patients with obesity complications. They were referred to specialist clinics in non-alcoholic fatty liver disease, diabetes mellitus, hypertension, and chronic kidney disease. Sixteen males and seventeen females aged 18-70 years, with BMI > 35 kg/m2 were recruited. Before the interview, participants watched a 60-minute video explaining nutritional therapy, pharmacotherapy, and surgery in equipoise. Data were collected in semi-structured interviews; Reflective thematic analysis was used. This sub study focuses only on patients who expressed specific attitudes (positive or negative) towards pharmacotherapy. RESULTS:Ten (30%) patients expressed a view on pharmacotherapy. Eight (24%) patients chose pharmacotherapy alone, whereas two (6%) patients chose pharmacotherapy combined with nutritional therapy. In this sub study focusing on pharmacotherapy, five themes were identified related to choosing whether or not to take medication: (1) attitudes towards pharmacotherapy, (2) attitudes toward size of obesity and its complications, (3) weighing the benefits and risks of treatment, (4) knowledge and reassurance of health professionals, and (5) costs associated with drug therapy. CONCLUSION:The primary concerns regarding pharmacotherapy for intentional weight loss were efficacy, side effects, lifelong dosing, pharmacokinetics, and cost. Providing access to information about all the pharmacotherapies and the benefits is likely to result in greater penetrance of treatment.

AIMS:To evaluate the effects of pragmatic home-based resistance exercise training on glycated haemoglobin (HbA1c) as well as muscle strength and body composition in people with type 2 diabetes.MATERIALS AND METHODS:People with type 2 diabetes were randomized (1:1) to usual care or usual care plus home-based resistance exercise for 32 weeks. The changes in HbA1c, body composition, physical function, quality of life, continuous glucose monitoring and liver fat were compared by randomized group using linear regression.RESULTS:This study recruited 120 participants (female: n = 46 [38%], age 60.2 (9.4) years, BMI 31.1 (5.4) kg.m-2 ), 64 to intervention and 56 to usual care. Intention to treat analysis revealed no effect on HbA1c (difference in difference: -0.4 mmol/mol, 95% confidence interval [CI]: -3.26, 2.47; p = 0.78) but the intervention increased the number of push-ups (3.6 push-ups, 95% CI: 0.8, 6.4), arm lean mass (116 g, 95% CI: 6, 227) and leg lean mass (438 g, 95% CI 65, 810) and decreased liver fat (-1.27%, 95% CI -2.17, -0.38), with no differences in other outcomes. Per-protocol analysis revealed similar results.CONCLUSIONS:Home-based resistance exercise is unlikely to lower HbA1c in people with type 2 diabetes but may be of benefit for maintaining muscle mass and function and reducing liver fat.

BackgroundThe outbreak of coronavirus disease 2019 (COVID-19) created unprecedented stress on physicians. Mindfulness is a type of meditation that focuses on being fully present, aware of senses, and emotions in the present moment without analyzing or judging them, and it may help reduce psychological distress in physicians. This study aimed to examine the effectiveness of virtual mindfulness-based intervention (MBI) on physicians’ perceived anxiety and depression and different facets of mindfulness.MethodsDuring the COVID-19 pandemic, an online survey was administered to physicians to assess depression, anxiety, and awareness using the 9-item Patient Health Questionnaire (PHQ-9), 7-item General Anxiety Disorder (GAD-7), and Five-Facets Mindfulness Questionnaire (FFMQ), respectively. Physicians that received the virtual MBI sessions also completed post-questionnaires at a 3-week follow-up time point.ResultsA total of 125 physicians responded to the online survey, with 56 completing the MBI. The prevalence of moderate to severe anxiety and depression was 45.0 and 46.7%, respectively. Mindfulness scores were negatively associated with depression (r = −0.38, P < 0.001) and anxiety (r = −0.36, p < 0.001). Mindfulness scores for the 56 physicians who received virtual MBI sessions were significantly improved (mean difference ± SD, 17.7 ± 16.1, p = 0.001). Significant reductions were also evidenced in anxiety (4.4 ± 4.2) and depression (4.5 ± 5.1) scores (p’s < 0.001). There was also an improvement in mindfulness facets of observing (5.1 ± 4.7), describing (2.3 ± 4.3), acting with awareness (2.7 ± 5.3), non-judging of inner experience (3.6 ± 6.1), and non-reactivity to inner experience (3.9 ± 4.0) (p’s < 0.001). A facet of mindfulness, acting with awareness was most efficiently associated with improved anxiety (B = −0.3, p = 0.02) and depression (B = −0.4, p = 0.01).ConclusionThis study has demonstrated that virtual MBI improved physicians’ psychological wellbeing and mindfulness during the crisis. Regular mindfulness practice may help physicians to tolerate and handle unpleasant circumstances, such as future epidemics or pandemics.

Abstract Objective Obesity and many of its comorbidities can be improved by nutritional therapy, lifestyle modification, pharmacotherapy, and surgical intervention. Relatively little is known about patients' preferences for the range of obesity treatments. The present study was undertaken to identify factors that may influence these preferences. By evaluating patient‐preferred treatment options and factors influencing patients, treatment adherence and efficacy may be improved. Our objective was to identify factors that influence patient preferences and subsequent choice of obesity treatment among those seeking treatment for obesity‐related complications. Methods Participatory action research, using purposeful sampling, was used to recruit 33 patients with obesity complications. Recruitment took place in specialist clinics for non‐alcoholic fatty liver disease, diabetes, hypertension, and chronic kidney disease. Sixteen males and 17 females aged 18–70 years with a BMI>35 kg/m2 were recruited. Prior to the interview, participants watched a 60‐min video explaining nutritional therapies, pharmacotherapies, and surgical therapies in equipoise. Data were collected in one‐to‐one semi‐structured interviews using zoom or the telephone; reflective thematic analysis was used. Results Four themes emerged: 1) structural factors, 2) autonomy, 3) interaction with formal care, and 4) the emotional and physical consequences of obesity. 39% of participants preferred nutritional therapy with support from medical professionals. 27% chose bariatric surgery. 24% chose pharmacotherapy alone, while 6% chose pharmacotherapy combined with nutritional therapy, 3% of participants wanted no intervention. Conclusion The challenges can be addressed by increasing support for healthcare professionals toward enhancing both their knowledge and the health literacy of patients. Future research should focus on improving access to treatment pathways for patients as well as developing health literacy programs and educational programs for healthcare professionals.

BackgroundThe mental health and wellbeing of people watching the Corona Virus Disease 2019 (COVID-19) pandemic unfold has been discussed widely, with many experiencing feelings of anxiety and depression. The state of mental health of medical staff on the frontlines providing care should be examined; medical staff are overworked to meet the demands of providing care to the rise in cases and deterioration in capacity to meet demands, and this has put them under great psychological pressure. This may lead to an increase in medical errors, affect quality of care, and reduce staff retention rates. Understanding the impact the pandemic has had on healthcare professionals is needed to provide recommendations to prepare for future crises.ObjectivesTo be able to meet the needs of the medical workforce on the frontlines and inform psychological support interventions and strategies for future pandemics, we aim to identify and explore the psychological impact of COVID-19 in Kuwait on healthcare professionals in close contact with patients.MethodsUsing semi-structured interviews, we conducted interviews between February and July 2021 with 20 healthcare professionals across Ministry of Health hospitals who were part of COVID teams. Interviews were transcribed verbatim, and analysis was conducted using principles of thematic framework analysis.ResultsThree themes emerged to help prepare future healthcare frontline workers on an individual, organizational, and national level: enhance self-resilience, a better-equipped workforce and healthcare environment, and mitigate stigma and increase public awareness.ConclusionThe results have assisted in highlighting areas of improvement to support the healthcare workforce in the current environment, as well as better prepare them for future pandemics. The findings have also provided insight to recommend targeted interventions. These should improve the psychological wellbeing and help in supporting healthcare professionals to reduce burnout, continue effective care of patients, and enhance resilience.

BACKGROUND:Plasma levels of angiopoietin-like protein 8 (ANGPTL8) are regulated by feeding and they increase following glucose ingestion. Because both plasma glucose and insulin increase following food ingestion, we aimed to determine whether the increase in plasma insulin and glucose or both are responsible for the increase in ANGPTL8 levels.METHODS:ANGPTL8 levels were measured in 30 subjects, 14 with impaired fasting glucose (IFG), and 16 with normal fasting glucose (NFG); the subjects received 75g glucose oral Glucose tolerance test (OGTT), multistep euglycaemic hyperinsulinemic clamp and hyperglycaemic clamp with pancreatic clamp.RESULTS:Subjects with IFG had significantly higher ANGPTL8 than NGT subjects during the fasting state (p < 0.05). During the OGTT, plasma ANGPTL8 concentration increased by 62% above the fasting level (p < 0.0001), and the increase above fasting in ANGPTL8 levels was similar in NFG and IFG individuals. During the multistep insulin clamp, there was a dose-dependent increase in plasma ANGPTL8 concentration. During the 2-step hyperglycaemic clamp, the rise in plasma glucose concentration failed to cause any change in the plasma ANGPTL8 concentration from baseline.CONCLUSIONS:In response to nutrient ingestion, ANGPTL8 level increased due to increased plasma insulin concentration, not to the rise in plasma glucose. The incremental increase above baseline in plasma ANGLPTL8 during OGTT was comparable between people with normal glucose tolerance and IFG.

Although many dietary and lifestyle interventions have been proposed, the concept of total dietary replacement (TDR) to achieve remission of type 2 diabetes in the Gulf region is new. With the high levels of obesity and type 2 diabetes in the region, offering TDR to patients for weight loss and remission of type 2 diabetes would assist in achieving health outcomes. The aim of the current study was to explore and understand remission of type 2 diabetes and TDR from the perspectives of dietitians to identify challenges and recommend solutions for implementation in Kuwait. A qualitative approach utilizing focus groups was chosen to explore the topic. Purposive sampling was used to gain experiences from a diverse sample across primary, secondary, and tertiary specialized diabetes centers. Discussions were audio-recorded and transcribed verbatim. Grounded theory using an iterative approach was applied to analyze the data. Three focus groups with a total of 17 participants achieved data saturation. The sample was varied in terms of workplace and years of experience. The three emerging themes were motivation to use the TDR approach, perceived challenges of TDR, and suggestions to improve and adapt approaches for Kuwait. Dietitians reported that remission of type 2 diabetes is a great motivator for patients to undergo TDR, although various factors were identified that may affect uptake including age, level of education, and social and cultural environment. By understanding dietitians’ perspectives, it has provided insight on views regarding the implementation of TDR to achieve remission in Kuwait and how best to tailor approaches by focusing on patient support needs and adopting a flexible approach.

BackgroundThe aim of the current study was to determine the prevalence of low muscle strength and to evaluate physical activity and sleep characteristics in people with type 2 diabetes in Kuwait. Additionally, equivalent data from the UK Biobank cohort were compared. MethodsPeople with type 2 diabetes from the UK Biobank (n = 23,570) and Kuwaiti cohorts (n = 3,135) were included in this cross-sectional study. Self-reported sleep, physical activity, and muscle strength were compared between the cohorts, using linear and logistic regression, with adjustments for age, sex, and duration of diabetes. ResultsPhysical activity levels (-937 (-1,097, -851) Met-min/week: standardized B-coefficient -0.42 (-0.47, -0.37)) and grip strength (3.2 (-3.58, -2.82) kg: standardized B-coefficient (-0.29 (-0.32, -0.26)) were lower in the Kuwaiti cohort, and the odds of having short sleep (OR 1.32 (1.19,1.46), being classed as inactive (OR 8.70 (7.59, 9.98), and having muscle weakness (OR 1.88 (1.69, 2.09) were higher. These analyses were adjusted for age, sex, and duration of diabetes. ConclusionsThe aim of the current study was to determine the prevalence of low muscle strength and to evaluate physical activity and sleep characteristics in people with type 2 diabetes in Kuwait. Additionally, equivalent data from the UK Biobank cohort were compared.