Correlation between Risk Stratification of Complications and Types of Antihyperglycemia Drugs with Incidence of Acute Diabetic Complications in Patients with Diabetes Mellitus during Ramadan Fasting

Laksmi Sasiarini,Charisma Dian Simatupang,Putu Moda Arsana

doi:10.21776/ub.crjim.2020.001.02.3

Laksmi Sasiarini, Charisma Dian Simatupang + Show 1 more

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https://doi.org/10.21776/ub.crjim.2020.001.02.3

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Abstract

Ramadan fasting for Diabetes Mellitus (DM) patients can lead to acute complications such as hypoglycemia, hyperglycemia, diabetic ketoacidosis (DKA) and thrombosis. Risk stratification predicts fasting safety of DM patients. Dose and timing of antihyperglycemia drugs adjusted during Ramadan fasting. Aim: To know the correlation between the risk stratification of Ramadan fasting and type of antihyperglycemia drugs with the incidence of acute complications in DM patients undergoing Ramadan fasting. Methods: DM patients in Endocrinology Clinic, dr. Saiful Anwar, General Hospital Malang who intend to fast during Ramadan classified in IDF-DAR risk stratification, conduct blood glucose monitoring and filled out a daily logbook during fasting. Results: Thirty-seven subjects were included in the study, only 1 patient with type-1 DM. Average fasting time is 18 days. Acute complications found higher in very high-risk group (5/6) compared to mild/moderate (2/13) and high-risk group (7/18) (p=0.009). Acute complications found higher in group with OAD and insulin combination regiment (2/4) compared to OAD (9/24) or insulin group (3/9) (p= 0. 731). One subject in very high-risk group suffered from acute coronary syndrome. Relationship between risk stratification and the incidence of hypoglycemia (p=0.040) and hyperglycemia (p=0.031) was significant. Relative risk in the very high-risk group was 2.538 compared to mild/moderate risk RR (95% CI)= 0.77 (0.62-0.96). Conclusions: There is a correlations between risk stratification and acute complications in DM patients undergoing Ramadan fasting. No relationship between type of antihyperglycemia drugs with acute complications of Ramadan fasting.

Highlights

Doing Ramadan fasting is one of the five pillars in Islam which obliges Muslims to refrain between dawn and dusk from food, drink, and all forms of immoral behavior that can make the fasting is not valid
This study aims to find out a correlation between risk stratification for complications and correlation between types of antihyperglycemic drug to the incidence of acute complication in Diabetes Mellitus (DM) patient who fasts in Ramadan
Et al.’s study showed the prevalence of hypoglycemia (21.7%) was a slightly higher than hyperglycemia (19.8%) in 327 DM patients who were fasting in Pakistan and there is no difference between prevalence of hypoglycemia and hyperglycemia in type-1 DM patient and type-2 DM patient during Ramadan.[11]

Summary

Introduction

Doing Ramadan fasting is one of the five pillars in Islam which obliges Muslims to refrain between dawn and dusk from food, drink, and all forms of immoral behavior that can make the fasting is not valid. Epidemiology of Diabetes and Ramadan (EPIDIAR) study in 2001 which investigated about the diabetic patient in 13 Islamic states resulted 42.8% type-1 DM patient and 78.7% type-2 DM patient who fast during Ramadan.[1] Indonesia is one of country with the largest Muslims population in the world. In 2015, there are 10 million of DM patients in Indonesia and 87.2% among them are Muslims (WHO-Diabetes country profile, 2015). There are some changes which are diet, sleep pattern, physical activities, dosage, the timing antihyperglycemic drugs consumption.[3] It is potentially causing an uncontrollable blood glucose in diabetes patients who fast during Ramadan. The diabetes patient who fasts can lead to acute complication such as hypoglycemic, hyperglycemic (with or without ketoacidosis), dehydration and thrombosis (IDF-DAR, 2016). [2]

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