Abstract
Aims
To describe the attitude of type 2 diabetes patients toward Ramadan fasting. A Secondary
purpose was to describe rates of hypoglycemia during Ramadan according to type of
treatment.
Methods
A prospective, non-randomized study for 2 years. Participants with type 2 diabetes
attending Dammam Diabetes Center, Saudi Arabia were stratified for fasting according
to ADA recommendations. Results are presented using mean, standard deviation and percentages.
Results
Total of 360 participants with type 2 diabetes. Mean ± SD glycosylated hemoglobin
was 8.9 ± 2.1. More than 80% of individuals were in the ADA higher risk group however,
they all fasted Ramadan. The mean non-fasting days was 2.6 days and overall rate of
hypoglycaemia was 24.7%. Both parameters were directly proportionate to the risk stratification
level (P-value <0.05). Despite hypoglycaemia, 29.3% continued fasting.
Hypoglycemia was highest in patients treated with insulin (P-value <0.05) followed
by those treated with oral agents including sulphonylurea as compared to oral agents
excluding sulfonylurea (P-value = 0.002). Those who experienced hypoglycemia prior
to Ramadan had the highest rate of hypoglycemia during Ramadan (53.3%) (P-value = 0.0065).
Conclusions
Despite medical advice, the vast majority of type 2 diabetes participants categorized
as high risk, fasted Ramadan. Approximately one quarter of people with type 2 diabetes
in our cohort experience hypoglycaemia and this was directly related to their fasting
risk level. A sizeable proportion continued the fast despite hypoglycemic. Insulin
therapy with or without oral agents and previous episodes of hypoglycemia before Ramadan
predicted hypoglycemia risk during Ramadan. HbA1c and weight showed some clinical
improvements post Ramadan fasting. This is a single center study of mostly high risk
fasting patients and hence, these results should not be generalized.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Diabetes Research and Clinical PracticeAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Sum cF, epidemiology of diabetes mellitus in the Asia-Pacific region.Ann Acad Med Singapore. 1990; 4: 501-550
- Recommendations for management of diabetes during Ramadan update 2010.Diabetes Care. 2010; 33: 1895-1902
- Diabetes and Ramadan: practical guidelines.Diabetes Res Clin Pract. 2017; 126: 303-316
- A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries.Diabetes Care. 2004; 27: 2306-2311
- CREED study: hypoglycaemia during Ramadan in individuals with type 2 diabetes mellitus from three continents.Diabetes Res Clin Pract. 2017; 132: 19-26
- “Targeted diabetes education” and glycemic control during ramadan fasting: an exploratory study.IJMBS. 2012; 4 (ISSN): 216-279
- Fasting during the month of Ramadan for people with diabetes: medicine and Fiqh united at last.Ibnosina J Med BS. 2009; 1: 58-60
International Islamic Fiqh Academy. Decree Number 183 (9/19) concerning diabetes and Ramadan fasting. IIFA’s council 19th session; 2009 April. Sharjah, UAE. http://www. qhacademy.org.sa [accessed June 11, 2009].
- Ramadan fasting alters endocrine and neuroendocrine circadian patterns. Meal-time as a synchronizer in humans?.Life Sci. 2001; 68: 1607-1615
- Cas clinique: croyances, Ramadan et diabète.Ann Endocrinol (Paris). 2004; 65: S68-S73
- Attitudinal determinants of fasting in type 2 diabetes mellitus patients during Ramadan.J Assoc Physicians India. 2011; 59: 630-634
- Premixed insulin treatment for type 2 diabetes: analog or human?.Diabetes Obes Metab. 2007; 9: 6309https://doi.org/10.1111/j.1463-1326.2006.00654.x.CrossRef,PubMed,Web of Science,Google Scholar
- GUIDE study: double-blind comparison of once-daily gliclazide MR and glimepiride in type 2 diabetic patients.Eur J Clin Invest. 2004; 34: 535-542
- The role of sulphonylureas in the management of type 2 diabetes mellitus.Drugs. 2004; 64: 1339-1358
- Evaluating the effect of Ramadan fasting on muslim patients with diabetes in relation to use of medication and lifestyle patterns: a prospective study.Int J Endocrinol. 2014; 6https://doi.org/10.1155/2014/308546
Article info
Publication history
Published online: April 01, 2019
Accepted:
March 25,
2019
Received in revised form:
March 1,
2019
Received:
January 19,
2019
Identification
Copyright
© 2019 Published by Elsevier B.V.
