Abstract
ObjectiveTo assess the role of the 24-hour helpline service in the management of diabetes during the holy month of Ramadan.MethodologyThis prospective study was conducted at the Baqai Institute of Diabetology & Endocrinology, Baqai Medical University, Karachi, Pakistan, between December 2017 and August 2018. Patients with type 1 and type 2 diabetes who were willing to observe the fast in Ramadan 2018 were included. Pre-Ramadan education on a one-to-one basis was given and the 24-hour helpline number was provided to each patient. Details of baseline characteristics, anthropometric measurements, and biochemical parameters (lipid profile, serum creatinine, urine D/R (protein), and glycated hemoglobin A1c pre- and post-Ramadan) were noted. Self-monitoring blood glucose (SMBG) recording books were provided to each patient to record blood sugar levels during Ramadan.ResultsA total of 102 patients, 41 (40.2%) with type 1 diabetes and 61 (59.8%) with type 2 diabetes were included. The mean age of patients with type 1 diabetes was 17.02±5.22 years and that of patients with type 2 diabetes was 49.48±9.68 years. Most of the patients were male in both groups. By using the 24-hour helpline service, 912 calls were made to patients, 502 calls for type 1, and 410 calls for type 2 diabetes. Mean HbA1c (%) level before and after Ramadan was 8.94±1.72 and 8.70±2.03 in patients with type 1 diabetes and 8.59±1.73 and 7.71±1.27 in patients with type 2 diabetes, respectively. In the last 10 days of Ramadan, the decreasing trends of mean self-monitoring of blood glucose (SMBG) in patients with type 1 diabetes was observed for pre-dawn meal (suhoor), pre-sunset meal (iftar), and before sleeping while this trend in type 2 diabetes was found in the pre-dawn meal (suhoor)and two hours after iftar.ConclusionPre-Ramadan diabetes education and treatment adjustment by using a station-based, 24-hour helpline service during the holy month of Ramadan have a significant role in controlling blood sugar levels, thus minimizing the complications of diabetes, facilitating timely adjustments in treatment, and reducing unnecessary hospital visits and admissions.
Highlights
Diabetes is one of the most alarming public health issues, especially for lower-middle-income countries [1]
A total of 102 patients, 41 (40.2%) with type 1 diabetes and 61 (59.8%) with type 2 diabetes were included
By using the 24-hour helpline service, 912 calls were made to patients, 502 calls for type 1, and 410 calls for type 2 diabetes
Summary
Diabetes is one of the most alarming public health issues, especially for lower-middle-income countries [1]. In Pakistan, 7.5 million people have diabetes as reported by the International Diabetes Federation (IDF) atlas [2]. Fasting (abstaining from food and drink from dawn to sunset) during the month of Ramadan is one of the five main pillars of Islam [4]. Most Muslims are passionate about fasting during this month, sick people are exempted. Many diabetics may not perceive themselves as sick and a high proportion fasts [5,6]. A large epidemiology study of Muslims with diabetes in 13 Islamic countries - the Epidemiology of Diabetes and Ramadan (EPIDAR) study - showed 43% of patients with type 1 and 79% of those with type 2 diabetes fasting during Ramadan [7]
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