Background: Fasting in patients with diabetes is perceived to be challenging. Aim: To identify awareness, practices, and experiences of diabetic patients before and during Ramadan. Method: We conducted an online survey of a convenience sample of 3190 diabetic patients attending 10 clinics from 3 countries, from April 1, 2021– May 31, 2021. The questionnaire, customised to choose vernacular language, comprised 30 questions, that addressed the three main domains: perceived gaps in current knowledge, behaviour and glycemic care practice. Information on socio-demographics characteristics, participation in the past Ramadan, advice from their healthcare providers was collected. Trained healthcare professionals collected the data on one-to-one basis. Data was analysed using GraphPad software. Results: The mean age (years) was 49.6 (SD±12.43, minimum 15, maximum 91, range 76, 95% CI 49.2 to 50.06). Among 3190 participants, 54.3% (n=1734) were females. The highest education level in 60.2 % (n=1921) was high school, followed by graduate (25.2%, n=1921) and postgraduates (14.5%, n=465). 40.1% (n=1281) reported that they did not undergo medical evaluation before Ramadan, while a higher proportion (87.8%, n=2803) intended a medical evaluation after Ramadan. 86.6% (n=2763) reported to fast during the last Ramadan in year 2020 and similar number intended to fast or fasted during Ramadan in 2021. 65.6% (n=2763) reported that diabetes did not pose a medical challenge during fasting in the last Ramadan during pandemic. 53.9 % (n=1721) were only taking oral medications, while 28.3 %(n=904) were on both oral therapy and insulins. 55.6% (n=1775) also had atleast one comorbidity due to hypertension, stroke, CKD or CHD. 31.1% (n=994) and 32% (n=1022) were not aware that during Ramadan there is increased risk of hypoglycemia and dehydration, respectively. 81% (n=2587) patients perceive that Ramadan helps to control diabetes. 77.8% (n=2482) were confident to control blood sugar levels during Ramadan. 78.2% (n=2497) are confident to fast during the whole month of Ramadan. 40.3% (n=1287) considered diabetes medication as barrier to fast, while 43.1% (n=1376) perceived finger pricking for glucose monitoring would break fast. 54.7% (n=1748) regularly monitor their blood glucose during non-fasting hours. 75.6 % (n=2413) practiced Tarawih regularly and similar number followed medical advice to alter the timing, dose, or frequency of anti-diabetic medications. 15.9% (n=508) do not have predawn meal (Suhūr). Iftar included calorie dense food for 66.5% (n=2124). 83.9% (n=2678) at Iftar, would prefer to eat a healthier, less calorie food. Discussion: Substantial number of patients consider that fasting helps to control diabetes. Diabetes education among these patients is necessary to allay the myths regarding hypoglycemia, side effects of the medications, fingerpicking and emphasize the importance of meal at Suhur. Pre-Ramadan medical evaluation needs to be encouraged to enable a better and healthier fasting experience during Ramadan.
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