The practices and outcomes of diabetic patients during ramadan fast: A survey in a specialist clinic

Abstract

Assessment was made by semi-structured interview of the practices and outcomes of diabetic patients during Ramadan fasting. Data collected included demographic data, diabetes details, medications and HbA1c levels. Patients were questioned about fasting, changes in medications, and outcomes in terms of hypoglycemia, hyperglycemia, and emergency hospital visits. Three hundred and thirteen nonpregnant adult patients were surveyed during the six weeks after Ramadan. Median age was 53 (range 11 to 87) years. One hundred and sixty nine patients (54%) were women and the majority were UAE nationals. The median duration of known diabetes was 10 years (range 1-35). The majority had type 2 diabetes (n=276 or 88%) and 37 patients had type 1 diabetes. The majority of patients with type 1 diabetes (n=30/38) received intensive insulin regimens. Patients with type 2 diabetes were treated with intensive insulin regimen (n=28 or 10%), twice daily insulin regimen (n=40 or 14%) and basal insulin (n=52 or 19%) with or without oral agents. Oral anti-diabetic therapy was used in 156 (57%). The mean HbA1c was 8.7% with a median of 8.1(5.5-17.6%) measured at a median of two months (range 1-12) before Ramadan. Fifteen patients did not fast (4.8%) of whom four did not fast for other medical reasons, and of the total five had type 1 diabetes. Fasting was observed by 258 patients (82%), for > 20 days by 31 patients (10%), between 10-20 days by 7 patients (2.2%) and for <10 days by two patients (0.6%). The total daily dose was unchanged in 209/298 (70%), was reduced by 83 (28%) and stopped completely by 5 patients (2%). Patients took their medication as three doses (6.4%), two doses (81%) or a single dose (12%). No hypoglycemia was reported in 253 patients. However, in 26, 6, and 11 patients hypoglycemia lead to breaking the fast in 1-3, 4-6 and >7 days respectively. Unusually high hyperglycemia was reported by 33 patients with values around 200-400 mg/dL. Admission to hospital was needed by three patients. In conclusion, most patients with diabetes do fast during Ramadan with changes in their medications' total dose and frequency. Hypoglycemia is the most common complication in insulin-dependent diabetic patients.