Biometric and metabolic changes in patients with diabetes prior, during and after the holy month of Ramadan (ABCD Study)

Hassanein, Mohamed; Abdelgadir, Elamin; Obaid, Hanan; Ahmed, Fayha Salah; Al-Sharhan, M.; Thabit, Salah; Haidar, Mai; Elsayed, Mohamed; Alawadi, Fatheya

doi:10.1016/j.diabres.2021.108678

Cited by 10 publications

(17 citation statements)

References 9 publications

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“…The prevalence of diabetes is increasing globally, especially in the Muslim majority regions of the Middle East, North Africa and South-East Asia 1 . The majority of Muslims observe fasting during Ramadan which has multiple clinical and metabolic benefits [2][3][4] , but can also be associated with complications, especially in relation to medication 5 . The Epidemiology of Diabetes and Ramadan (EPIDIAR) 6 study showed that 89% of patients with type 2 diabetes mellitus fasted during Ramadan, and it was also associated with an increased incidence of severe hypoglycemia and hyperglycemia.…”

Section: Introductionmentioning

confidence: 99%

Effect of Ramadan fasting in patients with type 2 diabetes mellitus treated with sodium–glucose cotransporter 2 inhibitors: A systematic review and meta‐analysis

Gad

Al-Nassr

Mohammed

et al. 2022

J of Diabetes Invest

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Aims/Introduction Sodium–glucose cotransporter 2 inhibitors (SGLT‐2i) improve glycemic control and weight, but might be associated with dehydration, hypotension and ketoacidosis, especially in patients with type 2 diabetes mellitus who fast during Ramadan. This meta‐analysis evaluates the effects of Ramadan fasting on patients with type 2 diabetes mellitus treated with SGLT‐2i. Materials and Methods A literature search was carried out in PubMed, Embase and the Cochrane Library. Quality assessment was carried out using the ROBINS‐I and Cochrane tools for risk of bias, and analyses were carried out using RevMan version 5.3. Results A total of five studies were included in this meta‐analysis. During Ramadan, there was a significant reduction in glycated hemoglobin (P < 0.00001) and diastolic blood pressure (P = 0.006), with a non‐significant trend for a reduction in weight (P = 0.44) and systolic blood pressure (P = 0.67). The number and severity of hypoglycemic episodes was lower in patients with type 2 diabetes mellitus treated with SGLT‐2i compared with sulfonylureas. There was no significant change in estimated glomerular filtration rate, β‐hydroxybutyrate, bicarbonate or anion gap. However, we identified considerable heterogeneity among studies, and a lack of head‐to‐head studies with structured outcome reporting on the risks and benefits of SGLT‐2i during Ramadan. Conclusions This systematic review and meta‐analysis shows that patients with type 2 diabetes treated with SGLT2i's during Ramadan have an improvement in HbA1c, less hypoglycemia and no major adverse effects.

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Section: Introductionmentioning

confidence: 99%

Effect of Ramadan fasting in patients with type 2 diabetes mellitus treated with sodium–glucose cotransporter 2 inhibitors: A systematic review and meta‐analysis

Gad

Al-Nassr

Mohammed

et al. 2022

J of Diabetes Invest

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“…Hassanein M et al, assessed the biochemical and biometric changes in patients with diabetes during ramadan in comparison to the pre-ramadan and post-ramadan and suggest low risk patient to fast as fasting is not associated with an increased risk. 20 Nor Azlin et al, in prospective cohort study also demonstrated the safety and tolerability of once or twice daily neutral protamine Hagedorn (NPH) insulin for pregnant women who wish to fast during ramadan, while there was a reducing trend in home readings with overall readings noted to be within acceptable limits. 21 …”

Section: Discussionmentioning

confidence: 99%

Fructosamine as an Index of Short-Term Glycemic Control in Pregnant Women with Diabetes: Before, During and After Ramadan

Ekhzaimy¹,

Alkatari²,

Al-Maatouq³

et al. 2022

IJWH

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Purpose Impact of ramadan fasting on healthy and women with diabetes is already known. However, there is a scarcity of data on impact of fasting on pregnant women with diabetes. Moreover, religious and medical recommendations advise pregnant women against fasting as it is unsafe. Despite being exempted, many pregnant Muslim women with diabetes still choose to fast during ramadan. This study investigated different glycemic marker as an indicator for diabetes control in fasting pregnant women. Patients and Methods This is a prospective observational study. A total of 89 pregnant diabetes women were recruited. Blood glucose was self-monitored in all the pregnant women using glucose monitoring device at home. We measure the fructosamine, HbA1c levels before, during and after ramadan. Results Pregnant women with type 1 diabetes were 14 (25%), type 2 diabetes were 21 (37.5%), and gestational diabetes were 21 (37.5%). The mean fructosamine level decreased during and after ramadan in gestation diabetes pregnant women compared to type 2 diabetes and type 1 diabetes pregnant women subjects (p = 0.009). Conclusion The present study indicates that pregnant women with diabetes were able to fast during ramadan and there fructosamine level reduced during fasting. Utilization of fructosamine for short-term monitoring of glycemic control in addition to home glucose monitoring in pregnant women with diabetes will provide a good index of glycemic control. Recommendation Religious and medical recommendations advise pregnant women against fasting as it is unsafe, and they are under high risk. However, if they insist to do fast, they must do under strict medical supervision and fructosamine can be used as a glycemic control marker.

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“…However, these physical benefits in people with T2D are still not very evident. A few studies [4,38,39] found a modest reduction in HbA1c, LDL-cholesterol and weight during Ramadan which were not sustained long after Ramadan. Studies on people with diabetes have shown that participating in Ramadan fasting can be beneficial to mental well-being, for instance, by reducing anxiety, depression and stress, which could be associated with the spiritual and social benefits of fasting during Ramadan [1].…”

Section: Discussionmentioning

confidence: 99%

“I am my own doctor”: A qualitative study of the perspectives and decision-making process of Muslims with diabetes on Ramadan fasting

Bouchareb

Chrifou²,

Bourik³

et al. 2022

PLoS ONE

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Background Many Muslims with diabetes choose to fast against medical advice during Ramadan, potentially increasing their risk of acute complications. Patients are often reluctant to disclose fasting to their health care providers, and their needs regarding Ramadan are not met in consultations. For healthcare professionals to provide patient-centred care, it is important to gain more insight into patients’ decision-making process. This study therefore aims to explore how Muslims with diabetes decide whether to fast during Ramadan. Methods A qualitative study was conducted consisting of 15 focus groups with Muslims with diabetes within a constructivist paradigm. Convenience sampling was used. All focus groups were transcribed verbatim and analyzed using Braun and Clarke’s reflexive thematic analysis. Results Four themes were found to be important in the decision on whether to fast: (1) values and beliefs concerning Ramadan, (2) experiences and emotions concerning Ramadan, (3) the perception of illness, and (4) advice from health care professionals, imams and family. Many participants indicated fasting against medical advice and trusting their subjective assessments on whether they could fast. Moreover, three main stages in the decision-making process for eventually refraining from fasting were identified: (1) the stage where positive experiences with fasting dominate, (2) the stage where one encounters challenges but their determination to fast prevails and (3) the stage where one decides to refrain from fasting after experiencing too many physical difficulties with fasting. Conclusions Muslims with diabetes experience autonomy in their decisions on Ramadan fasting. The decision to refrain from fasting often resulted from a difficult and dynamic decision-making process and was often made after participants reached their physical limits. These findings highlight the importance of not only shared decision-making to empower patients to make well-informed decisions on Ramadan fasting but also pre-Ramadan diabetes education to help people with diabetes have a safe Ramadan.

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Biometric and metabolic changes in patients with diabetes prior, during and after the holy month of Ramadan (ABCD Study)

Cited by 10 publications

References 9 publications

Effect of Ramadan fasting in patients with type 2 diabetes mellitus treated with sodium–glucose cotransporter 2 inhibitors: A systematic review and meta‐analysis

Effect of Ramadan fasting in patients with type 2 diabetes mellitus treated with sodium–glucose cotransporter 2 inhibitors: A systematic review and meta‐analysis

Fructosamine as an Index of Short-Term Glycemic Control in Pregnant Women with Diabetes: Before, During and After Ramadan

“I am my own doctor”: A qualitative study of the perspectives and decision-making process of Muslims with diabetes on Ramadan fasting

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