pre-Ramadan Education Research Articles

Diabetes self-management skills in patients considering Ramadan fasting: Sfax pre-Ramadan education workshops experience

Diabetes self-management skills in patients considering Ramadan fasting: Sfax pre-Ramadan education workshops experience

Development and Validation of an Educational Booklet for The Healthy Eating Management of Diabetes Mellitus During Ramadan Fasting

Background: iabetics who decide on Ramadan fasting are at risk of complications such as hypoglycemia, hyperglycemia, ketosis, or dehydration. The strategy for prevention is to provide education about managing DM with healthy food intake, medication, and exercise during Ramadan fasting. Therefore, it is essential to develop the media to implement education.Research Methods: This research was a research and development method. The model used in developing an educational booklet consists of four stages: define, design, develop, and disseminate. The feasibility of growing media was analyzed by the content validity index (CVI) using I-CV and S-CVI to assess whether the item is relevant or not relevant to the index CVI>0,80. Research Result: Define is the first stage to analyze the need for media development; based on the results of an online survey of nutritionists, as many as 71% mentioned that there were no specific educational media on healthy eating management for DM during Ramadan fasting. Design and development of educational media include literature studies on healthy eating during Ramadan fasting for DM, containing food menus during Ramadan fasting—subsequent dissemination by assessment from experts and target subjects. The assessing subject's content validity index (CVI) was carried out using the I-CV and S-CVI. The average value of I-CV is 0.875, and the average value of S-CVI is 0.875, meaning that all parts of the content are relevant in providing information about healthy eating for DM during Ramadan fasting. The reliability test by the target subject obtained Cronbach's alpha value of 0.850 was reliable. Conclusion: This booklet can be used as an educational medium for pre-Ramadan education. Then, the researchers developed this booklet by considering and improving the booklet design, which was stated to be appropriate.

Evaluation of physicians' approaches for the management of patients with diabetes during Ramadan in Iraq

Background/objectivesIn Diabetes Mellitus, fasting Ramadan comes with several challenges for both patients and physicians. However, majority of Muslims with type 2 diabetes fast Ramadan. Therefore, several guidelines have been developed to help physicians in managing their patients during Ramadan. This survey aims to investigate approaches adopted by Iraqi physicians for the management of diabetes during Ramadan. Design and methodsThis was a cross-sectional online survey based study conducted via Google forms from March 20 through March 27, 2021. The participants were specialist doctors from different regions in Iraq who were directly involved in management of people with diabetes mellitus. The Google form was distributed to the intended specialist doctors through an invitation link via emails and WhatsApp groups exclusive for specialist doctors from Iraq. The survey was completely anonymous and participants' confidentiality was maintained throughout the study. A total of 140 responses collected in this study. ResultsMajority of the participants were family physicians followed by internal medicine physicians and endocrinologists in the following rates 29.2 %, 27.1 % and 16.4 % respectively. Among the respondents, 94.3% reported giving advice to their patients regarding Ramadan fasting; 84.3% of this advice was based on several factors. Those who do not follow a specific guideline in their provision of care and depend on their experience represent 53%. Of them, family physicians were the predominant (70.2%). Pre-Ramadan education is provided by 75% of the participants. Minority (14.3%) allow patients with type 1 diabetes to fast Ramadan and 32.1% allow those with type 2 diabetes on insulin to fast. Recent diabetic ketoacidosis and recent severe hypoglycemia were the main causes for not allowing people to fast Ramadan, 79.3% and 74.3% respectively. Regarding treatment modification during fasting, 56.4 % of physicians change the frequency of administration. Lastly, 67.8 % scored 7/10 or above in the questions to test the familiarity of physicians with the established international guidelines. ConclusionsThis survey highlights the importance of medical education for doctors and the need for structural education programs directed to the family physicians, internists, and other treating physician regarding the current practical guidelines. Health care providers need to be familiar with current diabetes and Ramadan fasting guidelines.

Positive impact of pre-Ramadan education on glycemic control and reducing risk of hypoglycemia in type 2 diabetic elderly patients during COVID 19 pandemic

BackgroundElderly patients have higher risks for complications during Ramadan fasting. Educating patients is essential for fasting safely. AimTo evaluate the impact of pre-Ramadan education in reducing risk of hypoglycemia and achieving glycemic control in elderly. MethodsA prospective study carried out in outpatients clinics of Internal Medicine department in Assiut university hospital. It included 316 type 2 diabetic patients who intended to fast. They were grouped into 2 groups; < 65 years and ≥ 65 years patients. The patients received pre-Ramadan individual education sessions. A semi-structured questionnaire was used to collect the data to stratify the risk of fasting. The study was carried out in 3 phases. Assessment of hypoglycemia and biochemical parameters after the education was the primary outcome. ResultsFasting blood glucose decreased during and after Ramadan in elderly significantly (p = 0.0001). The patients who achieved fasting blood glucose less than 8 mmol/L increased from 29.3% to 46.6% after Ramadan in elderly patients. HbA1c decreased significantly after Ramadan (p = 0.001). The main cause of breaking fast was hypoglycemia in both groups; 9% vs.7.7% in patients < 65 and ≥ 65 years respectively. The waist circumference showed significant decrease in patient with 65 years old or more (p = 0.05). Total cholesterol and LDL increased with no statistical significance in patients ≥ 65 years (p = 0.512, 0.470). Both groups showed improvement of HDL cholesterol during and after Ramadan (P = 0.0001). ConclusionPre-fasting education had positive impact on decreasing the risk of symptomatic hypoglycemia in elderly diabetic patients.

AACE2021-A-1066: Evaluation of Physicians' Approaches for the Management of Patients with Diabetes During Ramadan in Iraq

In Diabetes Mellitus, fasting Ramadan comes with several challenges for both patients and physicians (1). However, majority of Muslims with type 2 diabetes (T2D) fast Ramadan (2). Therefore, several guidelines have been developed to help physicians in managing their patients during Ramadan (1, 3). This survey aims to investigate approaches adopted by Iraqi physicians for the management of diabetes during Ramadan. This was a cross-sectional online survey based study conducted via Google forms from March 20 through March 27, 2021. The participants were specialist doctors from different regions in Iraq who were directly involved in management of people with diabetes mellitus. The Google form was distributed to the intended specialist doctors through an invitation link via emails and WhatsApp groups exclusive for specialist doctors from Iraq. Repeat submissions from the same link were automatically blocked by the survey server. The survey was completely anonymous and participants' confidentiality was maintained throughout the study. A total of 140 responses collected in this study. Majority of the participants were family physicians followed by internal medicine physicians and endocrinologists in the following rates 29.2 %, 27.1 % and 16.4 % respectively. Among the respondents, 94.3% reported giving advice to their patients regarding Ramadan fasting; 84.3% of this advice was based on several factors (Table 1). Those who do not follow a specific guideline in their provision of care and depend on their experience represent 53%. Of them, family physicians were the predominant (70.2%). Pre-Ramadan education is provided by 75% of the participants. Minority (14.3%) allow patients with type 1 diabetes to fast Ramadan and 32.1% allow those with T2D on insulin to fast. Recent DKA and recent severe hypoglycemia were the main causes for not allowing people to fast Ramadan, 79.3% and 74.3% respectively (Table 2). Regarding treatment modification during fasting, 56.4 % of physicians change the frequency of administration. Lastly, 67.8 % scored 7/10 or above in the questions to test the familiarity of physicians with the established international guidelines. This survey highlights the importance of medical education for doctors and the need for structural education programs directed to the family physicians, internists, and other treating physician regarding the current practical guidelines. Health care providers need to be familiar with current diabetes and Ramadan fasting guidelines.

Fasting and diabetic care during Ramadan in Libyan peoples with diabetes in Tripoli Diabetes Endocrine Hospital

Background: The last epidemiological study regarding diabetes in Libya in year 2009 is estimated to reach 16.4%, This study is the up to date study regarding diabetes care during Ramadan in Tripoli. Study design: cross section study. Material and method: we interviewed 300 diabetic patient at outpatient Clinic in Tripoli Eiabetes and Endocrine Hospital for the frequency, the Incidence of complication of fasting and diabetic care during fasting Ramadan, the data was collected 4week after Eid Elifitr 1434 Hijri (2013) in structural questionnaire after a verbal consent. Collected data: coded and spss software used for analysis. Results: from total 300 Libyan diabetic patients 62% were females, 71.3% were type 2 diabetes. Mean age was 51.1±15.4 years, and mean duration of diabetes was 8.7±6.9 years, 85.3% had their HBA1C checked With last three month, mean HBA1C 8.9±3.1%,73% were complete fasted 29 days , hyper-hypoglycaemia at day time was the most commonly reported Complication especially during the 4th week of fasting, there is no significant difference between types of diabetes and gender in self monitoring of blood sugar, late sahour, preramadan education ,changes In dose of treatment(p&gt; 0.05). Conclusion: Most of diabetic patients in Libya mange to fast during Ramadan. Recommendation: pre Ramadan diabetic education is needed to avoid the serious complication.

The Utility of Flash Glucose Monitoring for Patients with Type 1 Diabetes Mellitus during Fasting in Ramadan

Aims The study aimed to assess the effectiveness of the Flash Glucose Monitor (FGM) in empowering patients with Type 1 Diabetes Mellitus (T1DM) to fast safely during the month of Ramadan. Methods In this prospective interventional study, eligible adult patients with T1DM were monitored with FGM and completed a survey after Ramadan. Time in range, glucose variability, changes in HbA1c, and renal function was evaluated. IRB approval and informed consent were acquired prior to the study. For data analysis (SPSS) Version 25 was used. Results The study included 8 adults (5 females, 3 males). The use of FGM enabled 25% of patients who were not able to fast in the previous year to fast in the current year.The median frequency of hypoglycemic episodes increased during Ramadan from 8 to 24 (p-value 0.049), however. Glucose variability during Ramadan was reduced by 4.05 ± 7.00 % but was not significant (p-value 0.17). The time in range before Ramadan was 51.00% ±10.75, during Ramadan was 53.42% ±14.83,and post-Ramadan was 55.85%± 10. HbA1cand creatinine did not change before and after Ramadan, (p-values of 0.465 and 0.315 respectively) indicating that glycemic control and renal function were maintained. Conclusion Active glucose monitoring using FGM coupled withstructured pre-Ramadan counseling and patient education aids in empowering patient to fast safely and maintain glycemic control during month of Ramadan and avoid complications including DKA and severe hypoglycemia. Keywords: Diabetes Mellitus; Flash glucose monitoring; Fasting, Ramadan; Time in Range.

Follow-up and treatment pattern during Ramadan and evaluation of the outcome of Ramadan fasting on clinical, biochemical and metabolic parameters in patients with type 2 diabetes mellitus: a realworld, multi-center, prospective observational study

Background: There are variable effects of Ramadan fasting on clinical and biochemical variables of diabetic people. Anti-diabetic agents are often adjusted during this time to reflect changes in lifestyle. The study was conducted to understand the diversity of follow-up, treatment pattern, clinical, and biochemical outcome of Ramadan fasting among type 2 diabetic patients who observed Ramadan fast.&#x0D; Methods: This real-world, multi-center, prospective, observational study was conducted at the diabetes outpatient department of National Healthcare Network (NHN) Uttara Center of Bangladesh Diabetic Somity (BADAS), Dhaka, Bangladesh and outpatient department of MARKS Hormone and Diabetes clinic, MARKS Medical College &amp;Hospital in Dhaka, Bangladesh upon randomly selected type 2 diabetic patients, recruited 1 to 12 weeks prior to the Ramadan and followed up till 12 weeks post-Ramadan period. Finally, a total of 271 participants completed satisfactory follow up. Data was collected before, during, and after Ramadan using a set of questionnaires in a face to face interview.&#x0D; Results: The majority (80.1%) of participants received pre-Ramadan education, counseling, adjustment of medication and other direction to help them cope with Ramadan fasting. A significant reduction of weight, body mass index (BMI)) and blood pressure were reported after Ramadan fast (p&lt;0.001). None of the studied participants experienced severe hyper/hypoglycemia or acute complications requiring hospitalization or an emergency room visit. Metformin was the commonest prescribed anti-diabetic medication. Premixed insulin was the commonest insulin regimen during study period. Three most commonly adjusted oral anti-diabetic drugs were gliclazide, glimepiride, metformin and insulin doses were also adjusted. Mean of fasting and prandial capillary blood glucose decreased from pre-Ramadan period to post-Ramadan period (P&lt;0.05). HbA1c decreased during post-Ramadan period compared to pre-Ramadan visit (P=0.13). A significant reduction in the triglyceride level was observed during post-Ramadan follow up (P&lt; 0.05).&#x0D; Conclusion: The study revealed that a safe fasting can be observed with proper pre-Ramadan work-up. Ramadan fasting resulted into significant reduction of weight, BMI, blood pressure, lipid profile and improved glycemic status in patients with type 2 diabetes.&#x0D; Birdem Med J 2021; 11(1): 30-38

Treatment Options for Patients with Type 2 Diabetes Mellitus during the Fasting Month of Ramadan

During Ramadan, Muslims fast from sunrise (Sahur) to sunset (Iftar) and are required to abstain from food and fluids, including oral and injectable medications. Patients with diabetes who fast during Ramadan are at risk of developing hyperglycemia with increased risk of ketoacidosis, hypoglycemia, dehydration and thrombosis. Pre-Ramadan education and preparation of a fasting patient are essential to reduce severe complications. This review paper summarizes studies to date on oral and injectable medications available for patients with type 2 diabetes during Ramadan fasting, as well as recommendations on management of these patients during Ramadan. Although there is limited data on the use of Metformin, Acarbose and Thiazolidinedione in Ramadan, they appear to be safe. Sulphonylurea, especially Glibenclamide, is associated with higher risk of hypoglycemia during Ramadan fasting, hence may need adjustment in dosing and timing. The incretin group and SGLT2 inhibitor use during Ramadan fasting is associated with low risk of hypoglycemia with no increased adverse events. Insulin regimes need to be individualized for patients who fast during Ramadan.

Achieving safer Ramadan fasting by keeping flexible glycemic targets during the day and tighter targets during the night in insulin treated people with type 2 diabetes

AimTo observe the effect of keeping flexible glycemic targets during fasting and tighter targets during non-fasting hours in insulin-treated people with type 2 diabetes during Ramadan. MethodsThis prospective study was conducted at Baqai Institute of Diabetology and Endocrinology in 2014. People with T2DM on split mixed insulin therapy were recruited. The pre-Ramadan education given and insulin doses were adjusted before Ramadan. 24-hour telephonic helpline service was provided to achieve pre-determined glycemic targets and minimize complications. ResultsA total of 54 people with T2DM with a mean age of 54.65 ± 9.32 years were recruited. Mean glucose levels achieved were 183.50 ± 30.91 mg/dl and 179.20 ± 36.27 mg/dl during the day and night respectively. Mean HbA1c (p-value < 0.0001) and serum creatinine (p-value 0.0010) significantly improved at the end of Ramadan. 0.6% episodes of hypoglycemia including one major hypoglycemia while 30% of episodes of hyperglycemia were recorded. No hospitalization needed. ConclusionBy keeping flexible glycemic targets during the day and tighter targets during the night, safe fasting was feasible with significant improvement in overall glycemic control without significant major complications.

Self-Monitoring of Blood Glucose and Hypoglycemia Association During Fasting in Ramadan Among Patients with Diabetes.

PurposeThe study aims to assess current practices of patients with diabetes to control blood glucose levels during Ramadan.Patients and MethodsA cross-sectional approach has been used for collecting data through a structured and interview-based questionnaire to assess the association between self-monitoring of blood glucose (SMBG) and hypoglycemia. The questionnaire has recorded information about demographics, duration of diabetes, and treatment of diabetes, and hypoglycemia complications faced during Ramadan. The primary outcomes of this study include frequency of SMBG during fasting in Ramadan and association of SMBG and hypoglycemia and break of fasting. However, the secondary outcomes include medications, glycemic control, and other influencing factors. The data was analyzed using Statistical Package of Social Sciences (SPSS) version 20.ResultsThe findings have shown that the majority of the patients used a combination of metformin+sulphonylurea (23.02%) following metformin+insulin (20.86%), insulin (12.94%), and metformin (8.63%). Whereas diet control, high or low blood sugar, insulin dose adjustment in fasting conditions were the most influential factors during Ramadan when the blood sugar levels were tested. Majority of the patients monitored their blood glucose level during pre-iftar (56.8%) following to hypoglycemia (30.2%), post-iftar (29.4%), and rarely monitored in afternoon (3.5%) despite that only 10.1% monitored their blood glucose on a daily basis. Patients who had symptoms of hypoglycemia and had to break their fasting at least once were 41% and 27.2%, respectively. There is a significant association between age and gender with symptoms of low blood sugar level. Additionally, a significant association between blood sugar monitoring and high blood sugar level has been shown (p=0.041), indicating that lack in daily blood sugar monitoring can increase the blood sugar level of a patient during Ramadan.ConclusionThe present study has helped in providing better understanding about the self-monitoring of blood glucose level and hypoglycemia. Furthermore, it also emphasizes the pre-Ramadan education about when to break their fasting along with frequency and timing of SMBG.

Role of 24-hour Helpline Service in the Management of Diabetes During the Holy Month of Ramadan.

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.

Culturally based pre-Ramadan education increased benefits and reduced hazards of Ramadan fasting for type 2 diabetic patients.

In the current study, we aimed at evaluating the effect of a culturally-based pre-Ramadan education program (PREP) on glycemic control, weight, adherence to post-sunset physical activity, perception of hypoglycemia, and anti-diabetic medication dose adjustment during Ramadan fasting in type 2 diabetics. A total of 1008 type 2 Diabetes patients were offered a culturally-based PREP in addition to the standard of care, two months before Ramadan. A retrospective interview one month after Ramadan compared the fasting experience of PREP attendees (470 patients) with those who merely received standard of care (538 patients) (Non-PREP). Ramadan fasting improved glycemic control with a correlation between HbA1c percent reduction and the number of fasting days (r = -0.290, p = 0.007). More HbA1c and weight percent reduction were observed in PREP attendees compared to the Non-PREP group (-14.8% ± 9.3 vs. -5.4% ± 5.4; p < 0.001; and - 1.96% ± 5.4 vs. -0.39% ± 2.8; p < 0.001, respectively). More commitment to night prayers in the PREP attendees compared to the Non-PREP group, (85.5% prayed >20 nights vs 28.4%; p < 0.001) with more HbA1c and weight percent reduction in the those who performed the prayers more than 20 nights compared to those who performed no prayers (-11.69% ± 8.8 vs -6.28% ± 6.4, p < 0.001; and - 2.76% ±5.1 vs 1.35% ±1.8, p < 0.001, respectively). More perception of true hypoglycemia was associated with PREP attendance (p0.046), insulin treatment (p0.000), and reduction of antidiabetic medication dosage (p0.004). Repeated lowering of antidiabetic medications doses with sequential downsizing of meals' portions, and appetite was reported. Ramadan fasting was beneficial for people with type 2 diabetes with reduction of HbA1c in correlation with the number of fasting days. Contrasting PREP with Non-PREP participants discovered better HbA1c and weight reduction in the former group even with equal number of fasting days. PREP participants performed more Taraweeh night prayers. The more the prayer nights the more decline of HbA1c and weight was observed. PREP improved perception and response to hypoglycemia with low-dosing of antidiabetic medications, especially insulin.

Knowledge, Attitude and Practice Regarding Ramadan Fasting and Related Determinants in Patients with Type 2 Diabetes at a Saudi Diabetes Clinic.

ObjectiveThis study was carried out in type 2 diabetes mellitus (T2DM) patients to assess their knowledge, attitude and practice about fasting during Ramadan and to identify the sociodemographic determinants of the knowledge, attitude and practice.MethodsA total of 107 T2DM patients were interviewed at a diabetes clinic in the Eastern Saudi Arabia. A questionnaire containing knowledge, attitude and practice questions about fasting during Ramadan was used to collect data. Data about age, gender, city of residence, nationality, level of education, and history of diabetes in family were also collected. Descriptive and inferential statistics were carried out using IBM-SPSS Version 21.ResultsThe mean total score for knowledge, attitude and practice was 16.5 ±3.72 (out of 27). The individual scores for knowledge, attitude and practice were: 9.67±2.53 (out of 16), 4.10±1.28 (out of 6), and 2.77±1.08 (out of 5), respectively. Gender (OR: 4.08, 95% CI: 1.05,15.79 and p<0.041), education (OR: 0.068, 95% CI: 0.008,0.594, p<0.015) and family history (OR: 5.086, 95% CI: 1.095, 23.630 p<0.038) were identified as independent determinants of the total score.ConclusionGender, Family history of diabetes and Education are determinants of knowledge, attitude and practice regarding fasting during Ramadan in the T2DM patients. A significant knowledge practice gap exists that necessitates further strengthening of the Pre-Ramadan education program for T2DM patients.

Factors Associated with Successful Fasting among Type 2 Diabetic Mellitus Patients during Ramadan: A Retrospective Recall Study

Among diabetic patients, fasting is associated with increased risk of ketoacidosis, hypoglycaemia and dehydration. Previous randomised controlled trials and prospective studies have shown that intensive pre-Ramadan education on fasting is able to help patients fast successfully during Ramadan. At the same time, observational studies show that many diabetic patients are still able to fast successfully throughout Ramadan despite deficiencies in knowledge about fasting practices. We conducted a retrospective recall study in Klinik Kesihatan Jalan Perak, Penang to determine the factors associated with successful fasting. Patients were selected using convenience sampling. Successful fasting was defined as a patient fasted as intended, and not having to break-fast due to hypo/ hyperglycaemia symptoms or hospitalization due to diabetic complications. Multiple logistic regression was used to determine independent factors associated with successful fasting. 113 patients were enrolled. 70.9% (n=80) of patients were able to fast successfully. Knowing the name of their diabetic medications were significantly associated with successful fasting (AOR=8.56, 95%CI: 2.04;35.8, p=0.003). Knowledge and fasting practices were not associated with successful fasting. We may identify patients who might not fast successfully by evaluating their understanding of their diabetic medications. They can then be targeted for further pre-Ramadan counselling. Nonetheless, an intensive pre-Ramadan counselling is still optimal if resources are available.

Assessing the awareness and care of people with diabetes related to Ramadan fasting; a-cross sectional study from Pakistan.

To assess the awareness level and care of people with diabetes related to Ramadan fasting across the country. This cross-sectional survey was conducted by Baqai Institute of Diabetology and Endocrinology, between November 2016 to March 2017, using convenient sampling. The physicians involved in the care of people with diabetes were invited to participate. A preformed validated questionnaire was used to conduct face to face interview on one to one basis. Altogether 2187 people with diabetes were enrolled. Knowledge related to Ramadan fasting was poor (35.64%), misconceptions were common (57.02%), and unsafe practices (55.62%) were highly prevalent. One third (31.9%) of the subjects did not receive pre-Ramadan education while medications adjustments were not made in nearly half of the study population. In this cross-sectional survey, we observed lack of awareness, misconceptions and unsafe practices among fasting people with diabetes across the country. Large scale awareness campaign is needed as comprehensive care is not widely available.

Impact of fasting during Ramadan in patients with type 2 diabetes mellitus

Purpose: Fasting during Ramadan is a religious obligation for Muslims. Extended fasting can create undesirable acute complications of diabetes such as hypoglycemia or hyperglycemia. In this study, we aimed to evaluate the impact of fasting on glucose regulation in diabetic patients who fast during Ramadan.Materials and Methods: Patients were informed about the possible side effects of fasting for them and those who stated that they will be fasting during Ramadan were called one month after Ramadan. In this retrospective cohort study by telephone interview, the number of fasting days, daily measurements of glucose, the number of acute complications if existed and whether the patients have changed their treatments were asked.Results: Forty six patients were included in this study. Mean age was 54.3±9.5 yr. The average fasting day was 25.24±2.4. They were categorized according to the risk stratifications. The number of hypoglycemic events was not higher than detected six months prior to the Ramadan. Most of the patients had hyperglycemia rather than hypoglycemia. All of the patients who had hypo-or hyperglycemia did not interrupt their fasting and did not change their medications. Conclusion: Patients who fasted during Ramadan have a tendency both hypoglycemia and hyperglycemia. To improve glycemic regulation and keep these patients in a safe and acceptable glucose range, Pre-Ramadan education is necessary.

Pre-Ramadan Education: A Necessary Tool for People with Diabetes to Fast Safely

Fasting in the month of Ramadan is one of Islam's five pillars. Fasting during this holy onth is mandatory for all healthy adult Muslims. There are 148 million Muslims with diabetes, around the globe and a significant number of them fast during Ramadan. Some of the health experts do not consider fasting to be safe in people with diabetes. While others, based on their own experience supported by the accumulating scientific evidence, contradict this and consider fasting to be safe for people with diabetes, provided they are furnish Pre-Ramadan education and given an individualized treatment plan.

Diabetic hypoglycaemia during Ramadan fasting: A trans-national observational real-world study

ObjectivesTo describe the risk of hypoglycaemia during Ramadan and determine its risk factors, and the impact of hypoglycaemia on patients' behaviour. MethodsA cross-sectional multi-country observational study, with data captured within 6 weeks after Ramadan 2015. Patients' and disease characteristics and its management, the risk of hypoglycaemia and patients' response to hypoglycaemia were recorded. ResultsA cohort of 1759 patients; majority with type 2 diabetes mellitus from North Africa, Arabian Gulf, Saudi Arabia, and the Indian subcontinent. Hypoglycaemia was reported by 290 patients (16.8%); particularly affecting type 1 diabetes patients and in insulin-treated patients in general. Age was significantly younger in the hypoglycaemia group (P < 0.001). The commonest responses were reducing the dose or frequency of medications (42%), attending primary care providers (24.5%) or increasing monitoring (20.7%). Fasting was interrupted by 67% only of those who experienced hypoglycaemia and recourse to emergency services was pursued by less than a quarter of patients with hypoglycaemia. The country-wise analysis of the rates of hypoglycaemia was greatest in Egypt (51.3%) and lowest in Pakistan (3.5%). ConclusionsHypoglycaemia is a significant complication of fasting during Ramadan. It may be predicted by type of diabetes, and use of insulin. Patients’ responses are varied and call for more formal pre-Ramadan education.

Outcome of focused pre-Ramadan education on metabolic and glycaemic parameters in patients with type 2 diabetes mellitus

BackgroundRamadan fasting is associated with the risk of acute complications including hypoglycaemia. Therefore, patients' education before Ramadan and follow up during Ramadan is essential for safe fasting. ObjectivesTo evaluate the effect of pre-Ramadan education program on biochemical parameters and the risk of hypoglycaemia in patients with type 2 diabetes mellitus. MethodsA prospective interventional controlled design was carried out on 320 Muslim patients with type 2 diabetes. They were divided into 2 groups; the control group (n = 200) who received standard diabetic care and the intervention group (n = 120) who received focused individualized diabetic education sessions before Ramadan. The study was carried out on 3 phases (before, during and after Ramadan). Post-education change of hypoglycaemia risk and biochemical parameters during Ramadan fasting were the primary outcomes. ResultsFasting blood glucose decreased significantly during, and after Ramadan in both groups (P < 0.001). Hypoglycaemia during fasting occurred in 4.1% of patients in the intervention group vs. 19.5% in the control group. Post Ramadan reduction of HbA1c < 7% increased statistically significantly in the intervention group (from 20.8% of patients before Ramadan to 55.8% after Ramadan). Low-density lipoprotein cholesterol decreased in the intervention group (P = 0.024). The body weight of the patients did not significantly change in both groups. ConclusionThere was a significant impact of pre-Ramadan educational program on reduction of hypoglycaemic risk and other acute complications, reduction of low-density lipoprotein cholesterol and improvement of high-density lipoprotein cholesterol. Therefore, it is recommended for the fasting patients especially those with high and very high risk during Ramadan.