“Targeted diabetes education” and glycemic control during ramadan fasting: An exploratory study

Abstract

Background: Management of diabetes during Ramadan fasting may be taken as a classical example of culturallysensitive care in some parts of the world. Several medical problems face diabetic patients who choose to fast. Objectives: To evaluate the effect of a locally-designed “targeted diabetes education” initiative on glycemic control of patients who intended to fast during Ramadan. Patients and Methods: This is a prospective cohort, controlled, non-randomized study. Seventy-one patients were recruited (46 women, 25 men); 10 had type 1 diabetes and 61 had type 2 diabetes. Of these, 51 patients were allocated to the intervention group, 13 were controls; 7 dropped out of the study. The “Targeted Diabetes Education” program included 2-3 educational visits to diabetes educators and 2-3 dietary counseling sessions before, during, and after Ramadan, in addition to telephone counseling and support. Home glucose monitoring was recommended to be performed in both the preprandial and 2 hour post prandial states at least 3-6 times per week plus recording of all hypoglycemic events. There was no deliberate intensification of medication for any patient. Outcome Measures: Risk stratification of patients was conducted according to the 2005 American Diabetes Association (ADA) guidelines. Preprandial and postprandial blood glucose levels, serum fructosamine, and hypoglycaemic episodes were measured during and after Ramadan. HbA1c, body weight changes and lipid profiles were also measured before and after Ramadan fasting. Results: More than 60% of the diabetic patients who fasted during Ramadan were in the higher risk groups (very high risk category 33.8%, high risk category 29.6%). Mean fasting blood glucose was reduced by 57 mg/ dL (95% CI, 21 - 94; p=0.005) in the intervention group. Mean HbA1c was lower in the intervention group by 1.5% (95% CI, 0.5 - 2.6; p=0.007) compared with the controls. Although serum fructosamine was reduced by 0.1 mmol/L (95% CI, -0.9 - 0.8; p=0.84) in the intervention group, this was not statistically significant. Mean difference in total cholesterol was 9.6 mg/dL (95% CI, -37.5 - 18.3; p=0.5) and in triglycerides 19.6 mg/dL (95% CI, -5 – 12; p=0.23) for the intervention group. Number of hypoglycemic events was significantly lower in the intervention group; 94% had no events compared to 73% in the control group. Mean difference in body weight was 0.4 kg (95% CI, -3.0 - 3.8: p=0.81). Conclusion: Targeted diabetes education is effective in achieving better glycemic control and reducing the risk of hypoglycemia in diabetic patients who fast during Ramadan. Therefore, more Muslim patients with diabetes who wish to fast during Ramadan can do this safely.