Attitude and safety of patients with diabetes observing the Ramadan fast

Real-world safety and effectiveness of insulin glargine 300 U/mL in participants with type 2 diabetes who fast during Ramadan: The observational ORION study

“…The majority of patients in CREED were treated with oral anti-hyperglycaemic drugs, with around 20% of participants treated with both oral anti-hyperglycaemic and injectable drugs and only 5% of participants receiving injectable medications alone. In DAR-MENA, 57.3% of participants fasted for the duration of Ramadan; only one third were treated with insulin, 62% of whom changed their dose [7]. In contrast, in the ORION study a higher percentage of participants (85.0%) fasted for the duration of Ramadan, all received insulin and the majority (88.6%) received non-insulin antihyperglycaemic treatments alongside insulin.…”

“…High HbA 1c levels (! 8%) in the pre-Ramadan period are common in participants in studies investigating the effects of fasting during Ramadan [7,19].…”

“…This evidence base includes a number of other studies, including the randomised controlled trial LixiRam (in which lixisenatide plus basal insulin was associated with lower rates of any hypoglycaemia compared with sulfonylurea plus basal insulin in participants with T2DM who fasted during Ramadan [20]) and the epidemiological studies CREED and DAR-MENA [3,7]. CREED was a large retrospective worldwide study in 13 countries [3] and DAR-MENA was a prospective, observational study in countries in the Middle East/North Africa region [7]. In CREED, the treatment regimen was modified before Ramadan for 39% of patients, and over 50% of participants fasted for the entire Ramadan period [3].…”

“…People with T2DM are at greater risk of hypoglycaemia during Ramadan compared with the rest of the year [5,6]. Studies within this population have shown that rates of severe hypoglycaemia increase during the Ramadan period; the DAR-MENA study observed a 4.5-fold increase in severe hypoglycaemic events during Ramadan compared with the 4weeks prior to Ramadan [7], while the EPIDIAR study observed a 7.5-fold increase in severe hypoglycaemic events during Ramadan compared with the preceding year [8]. In both studies, fewer than half of the participants changed their diabetes treatment dose during Ramadan (approximately one third of participants were treated with insulin, with or without oral anti-hyperglycaemic drugs) [7,8].…”

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

“…Since a great majority of DM patients chose to fast, much more than the proportions of DM with good control, a significant proportion of them have chosen to fast despite having high risk of acute DM complication (Malek et al 2019;Ba-Essa et al 2019). This unsafe fasting also included poor self-management in self-blood glucose monitoring (SMBG), where an estimated 46% to 83% did SMBG during Ramadan (Gaborit et al 2011;Malek et al 2019;Savas 2016;Ba-Essa et al 2019) and 27-52.2% refused to break their fast despite having symptoms of hypoglycaemia (Gaborit et al 2011;Babineaux et al 2015;Ba-Essa et al 2019). A few multinational studies, one of which Malaysia was one of the participating counties, showed many patients were not well prepared and have poor knowledge of self-care practice (Salti et al 2004;Babineaux et al 2015;Gaborit et al 2011).…”