Diabetes and Ramadan: An Update On Use of Glycemic Therapies During Fasting

Abstract

The fasting of Ramadan is observed by a large proportion of Muslims with diabetes. Recommendations for the management of diabetes during Ramadan were last published in 2005 by the American Diabetes Association. Several studies in this field have since been published, some addressing the use of new pharmacological agents in managing diabetes during Ramadan. The incritin memetics are potentially safe during Ramadan; the DPP4 inhibitors vildagliptin and sitagliptin provide an effective and safe therapeutic option, administered either alone or in combination with metformin or sulfonylureas. There are no published studies on the use of GLP-1 receptor agonists during Ramadan. Among the sulfonylureas, gliclazide MR (modified release) and glimepride can be safely used during Ramadan, but glibenclamide should be avoided due to the associated risk of hypoglycemia. In selected patients with type 1 and type 2 diabetes, the long-acting insulin analogues glargine and detemir, as well as the premixed insulin analogues, can be used with minimal risk of metabolic derangement or hypoglycemia; the risk is higher in type 1 diabetes. Insulin pumps can potentially empower patients with diabetes and enable safe fasting during the month of Ramadan. Further clinical trials are needed to evaluate the safety and efficacy of new antidiabetic agents and new diabetes-related technologies during Ramadan.

Vildagliptinvssulfonylurea in Indian Muslim diabetes patients fasting during Ramadan

“…Although Islamic rules exempt patients with illnesses from fasting, almost 79% of patients with type 2 diabetes mellitus prefer to fast; therefore, it is essential to make fasting as safe as possible [5] . As the fast is absolute in nature, that is, without water and food from dawn to dusk, hypoglycemia presents a serious risk [1] . Prolonged fasting in the absence of adequate insulin can cause excessive gluconeogenesis leading to hyperglycemia.…”

“…Worldwide, about 40-50 million Muslim patients with type 2 diabetes mellitus observe fasting during the holy month of Ramadan [1] . India has the world's largest diabetes population, with an estimated 51 million affected individuals [2] .…”

Prise en charge des patients diabétiques au cours du jeun du Ramadan: application des recommandations internationales en pratique clinique

“…Selon l’étude EPIDIAR seulement 62% des patients DT2 et 68% des patients DT1 reçoivent un avis spécialisé et un ajustement thérapeutique durant le mois de Ramadan [ 3 ]. A partir de ces constatations plusieurs propositions de prise en charge du diabétique pendant le Ramadan ont été publiées, nous citons les recommandations américaines (American Diabetes Association, ADA) publiées en 2010 [ 4 ] et asiatiques (South Asian Consensus Guideline) [ 5 ], ainsi que les propositions thérapeutiques d’Arabie Saoudite [ 6 ]. L’objectif de notre étude est d’évaluer l’impact du jeûne sur des paramètres anthropométriques notamment le poids, sur la tension artérielle (TA) systolique et diastolique et sur l’équilibre glycémique (HBA1C) chez des patients préparés au jeûne selon les recommandations internationales par un ajustement thérapeutique et une séance d’éducation sur la diététique et la conduite du jeûnee.…”

Filling the Knowledge Gap in Diabetes Management During Ramadan: the Evolving Role of Trial Evidence

“…Although a variety of other guidance documents have been published offering recommendations on diabetes management during religious fasting [ 3 , 15 – 25 ], there is currently no gold standard based on comprehensive, up-to-date, evidence-based recommendations. A major reason is that evidence from clinical trials in non-fasting populations, which form the basis for major international diabetes treatment guidelines, is not completely transferable to populations who engage in religious fasting.…”