Fasting the Holy month of Ramadan constitutes one of the five pillars of the Muslim faith. Although there is some evidence that intermittent fasting during Ramadan may be of benefit in losing weight and cardiometabolic risk factors, there is no strong evidence these benefits apply to people with diabetes. The American Diabetes Association/European Association for the Study of Diabetes consensus recommendations emphasize the importance of patient factors and comorbidities when choosing diabetes medications including the presence of comorbidities, atherosclerotic cardiovascular disease, heart failure, chronic kidney disease, hypoglycemia risk, weight issues and costs. Structured education and pre-Ramadan counseing are key components to successful management of patients with diabetes. These should cover important aspects like glycemic targets, self-monitoring of blood glucose, diet, physical activity including Taraweeh prayers, medication and dose adjustment, side effects and when to break the fast. The decision cycle adapted for the specific situation of Ramadan provides an aid for such an assessment. Children with type 1 diabetes should strongly be advised not to fast due to the high risk of acute complications such as hypoglycemia and probably diabetic ketoacidosis (DKA), although there is very little evidence that DKA is increased in Ramadan. Pregnant women with diabetes or gestational diabetes should be advised to avoid fasting because of possible negative maternal and fetal outcomes. Hypoglycemia is a common concern during Ramadan fasting. To prevent hypoglycemic and hyperglycemic events, we recommend the adoption of diabetes self-management education and support principles. The use of the emerging technology and continuous glucose monitoring during Ramadan could help to recognize hypoglycemic and hyperglycemic complications related to omission and/or medication adjustment during fasting; however, the cost represents a significant barrier.

Background Fasting during the holy month of Ramadan is one of the five pillars of Islam. Fasting is not meant to create excessive hardship on the Muslim individual according to religious tenets. It is important that health professionals are aware of potential risks associated with fasting during the month of Ramadan (mainly hypoglycemia and hyperglycemia). Aims To explore the impact of applying the principles of our 2020 recommendations for the management of type 2 diabetes (T2D) during the month of Ramadan. Methods A multinational randomized controlled trial (RCT) was conducted in five Muslim majority countries. Six hundred and sixty participants were deemed eligible for the study; however, 23% declined to participate later for various reasons. In total, 506 participants were enroled and were equally randomized to the intervention or the control group. At the end of the study, data from 231 participants in the intervention group and 221 participants from the control group were collected after 12.6% and 8.7% were, respectively, lost to follow‐up. Participants were randomized to receive a Ramadan‐focussed education with treatment for diabetes adjusted as per our 2020 recommendation update compared with the local usual care (control group). Results are presented using mean, standard deviation, odds ratio (OR), and percentages. Results At the end of the study, the number of hypoglycemic episodes in the intervention group was less than in participants who received usual care. The intervention group had significantly lower severe hypoglycemia compared to the control group with an OR of 0.2 [0.1–0.8]. Compared to baseline, both groups had a significant reduction in glycated haemoglobin (HbA1c), but the improvements were significantly greater in the intervention group. Whilst body weight reduced and high‐density lipoprotein cholesterol increased with the intervention, these changes were not significantly different from usual care. Conclusions A pre‐Ramadan assessment of people with T2D coupled with pre‐Ramadan education and an adjustment of glucose‐lowering treatment as per our updated 2020 recommendations can prevent acute complications and allow a safer fast for people with T2D. We have shown that such an approach reduces the risk of developing severe hypoglycemia and improves the metabolic outcomes in people with T2D.

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Background: Acute diarrhea is a major cause of morbidity and mortality in children, particularly in developing countries (the second cause of death). Probiotics and symbiotics are recent treatments for this disease, especially in the acute phase. Our objective is to compare probiotic or symbiotic treatment against placebo in acute diarrhea by following the evolution of diarrhea in terms of hours, number of bowel movements, volume of stools and their consistency. On a larger scale, we want to find a cost-effective intervention that reduces the morbidity and mortality of diarrhea. Methods: Eighty-three children aged 6 months to 5 years, from three different regions of Mount Lebanon, were randomized to receive a probiotic, a symbiotic or a placebo once daily for 5 days. Patients were excluded from the study if they had any history of a chronic disease. The statistical analysis was carried out on SPSS v22.00 Results: Out of 120 surveys distributed to parents, 84 were completed: 43 patients received probiotics (nine received Lactobacillus, 21 received spores, and 13 patients received yeast), 24 received symbiotics and 17 were controls. Stool consistency normalized on day 4 in the probiotics and symbiotics groups (P = 0.009). Less number of days with fever (P = 0.018) were observed in the probiotic and symbiotic groups (1 day) compared to placebo (4 days). No difference in the symptoms associated with diarrhea was observed in the different groups. Conclusions: Probiotics and symbiotics normalized stool consistency in pediatric diarrhea by day 4 and decreased the number of days with fever compared to control. Our study did not show a statistically significant difference between the different probiotics and symbiotics for the treatment of diarrhea.