Diabetes telemonitoring reduces the risk of hypoglycaemia during Ramadan: a pilot randomized controlled study

Lee, J. Y.; Lee, S. W. H.; Nasir, Nazrila Hairizan; How, Soon Hin; Tan, Christina San San; Wong, Chin Chin

doi:10.1111/dme.12836

Cited by 43 publications

(62 citation statements)

References 7 publications

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“…The results from the group discussions echo previous findings related to the interface between formal care, the impact of the family and the community, beliefs and perceptions regarding fasting, religious influence, and managing blood glucose during Ramadan (Almansour et al, ; Gaborit et al, ; Lee et al, , ; Mygind, Kristiansen, Wittrup, & Nørgaard, ; Patel et al, ; Peterson et al, ). People with diabetes have been shown to fast despite their HCP advising against the practice (Chowdhury, Khan, Lasker, & Choudhary, ), and this was confirmed by the workshop participants when relating their experiences prior to DAFNE.…”

Section: Discussionsupporting

confidence: 78%

Fasting in Ramadan with type 1 diabetes: A dose adjustment for normal eating workshop in Kuwait

Alsaeed

Al-Kandari

Al-Ozairi

2019

Health Soc Care Community

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This pre‐Ramadan workshop was aimed at educating and counselling people with type 1 diabetes, who graduated from the Dose Adjustment for Normal Eating (DAFNE) Kuwait programme, on safe fasting practices as well as determining their views on the challenges associated with fasting. The workshop also served as a pilot for a Ramadan‐specific module to inform its implementation in all DAFNE programmes with the goal of meeting the needs of Muslim DAFNE graduates wishing to fast safely. A 2‐day workshop (5 hours each) was conducted at DAFNE Kuwait 3 days before the start of Ramadan 2018 and all DAFNE graduates were invited to attend. The workshop consisted of group discussions about fasting‐related challenges, followed by three interactive lectures and hands‐on experience with popular Ramadan dishes. A qualitative approach was employed to determine the experiences of the participants with fasting by conducting three focus group discussions. The discussions were recorded via handwritten notes and analysed thematically. Seventy‐two people with type 1 diabetes attended and 47 participated in the group discussions. Participants discussed their past experiences with fasting and the associated challenges, and shared practices adopted over the years. In addition, they confirmed the positive impact of DAFNE on their fasting experiences. The workshop provided a platform for people with type 1 diabetes to share their experiences with fasting and learn how to fast safely. Furthermore, it provided preliminary information that can be further explored to inform recommendations for safer fasting practices and the implementation of a specific fasting curriculum for people with type 1 diabetes.

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Section: Discussionsupporting

confidence: 78%

Fasting in Ramadan with type 1 diabetes: A dose adjustment for normal eating workshop in Kuwait

Alsaeed

Al-Kandari

Al-Ozairi

2019

Health Soc Care Community

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“…The Diabetes Control and Complications Trial (DCCT) showed that tight glycemic control reduces the risk of complications and progression of microvascular complications (nephropathy, neuropathy, and retinopathy) in patients with type 1 diabetes (The Diabetes Control Complications Trial Research Group, 1993). The use of technological innovation in routine practice represents an attractive option for improving outcomes in these patients as several studies have demonstrated the feasibility and acceptability of using telemedicine (Farmer et al, 2005; Charpentier et al, 2011; Lee et al, 2015, 2016) in diabetes management.…”

Section: Introductionmentioning

confidence: 99%

Telemedicine for the Management of Glycemic Control and Clinical Outcomes of Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

2017

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Importance: Telemedicine has been shown to be an efficient and effective means of providing care to patients with chronic disease especially in remote and undeserved regions, by improving access to care and reduce healthcare cost. However, the evidence surrounding its applicability in type 1 diabetes remains scarce and conflicting.Objective: To synthesize evidence and quantify the effectiveness of telemedicine interventions for the management of glycemic and clinical outcomes in type 1 diabetes patients, relative to comparator conditions.Data Sources: MEDLINE, EMBASE, Cochrane Library, Web of Science, PsycINFO, and CINAHL were searched for published articles since inception until December 2016.Study Selection: Original articles reporting the results of randomized controlled studies on the effectiveness of telemedicine in people with type 1 diabetes were included.Data Extraction and Synthesis: Two reviewers independently extracted data, assessed quality, and strength of evidence. Interventions were categorized based upon the telemedicine focus (monitoring, education, consultation, case-management, and peer mentoring).Main Outcome and Measure: Absolute change in glycosylated hemoglobin A1c (HbA1c) from baseline to follow-up assessment.Results: A total of 38 studies described in 41 articles were identified. Positive effects on glycemic control were noted with studies examining telemedicine, with a mean reduction of 0.18% at the end of intervention. Studies with longer duration (>6 months) who had recruited patients with a higher baseline HbA1c (≥9%) were associated with larger effects. Telemedicine interventions that involve individualized assessments, audit with feedback and skill building were also more effective in improving glycemic control. However, no benefits were observed on blood pressure, lipids, weight, quality of life, and adverse events.Conclusions and Relevance: There is insufficient evidence to support telemedicine use for glycemic control and other clinically relevant outcome among patients with type 1 diabetes.

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“…The included participants were patients with diabetes who fasted for at least 10 days during Ramadan of 20146610 patients with diabetes—6350 T2D patients and 260 T1D patientsNMBefore Ramadan, approximately 48% of participants received Ramadan-specific diabetes education and nearly 66% patients were recommended to alter their medications timing and dosage, while about 70% received dietary advice. Receiving Ramadan-specific diabetes education helped participants to follow Ramadan-specific diabetes management recommendations during Ramadan better than those who did not receive such educationLee et al [37]MalaysiaA pilot randomized controlled study to evaluate the short-term benefits of a telemonitoring-supplemented focused diabetic education compared with education alone in participants with T2D who were fasting during RamadanRandom selection from five primary health care provider practices to telemonitoring group (TG) or a usual care group (UC)37 T2D patients: in the tele-monitoring group ( n = 18) who received goal-setting and personalized feedback and 19 T2D patients receiving Ramadan-focused pre-education only, i.e., usual careNMThe TG experienced fewer hypoglycemia symptoms compared to the UC during the study period (88 vs. 157 episodes), (OR 0.1273; 95% CI 0.0267–0.6059, p > 0.01) (effect size = −1.14*). However, there was no significant difference observed in glycemic control at the end of study between the two groups.…”

Section: Resultsmentioning

confidence: 99%

Fasting, Diabetes, and Optimizing Health Outcomes for Ramadan Observers: A Literature Review

2017

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IntroductionGlobally, and in Australia, diabetes has become a common chronic health condition. Diabetes is also quite prevalent in culturally and linguistically diverse pockets of the Australian population, including Muslims. There are over 90 million Muslims with diabetes worldwide. Diabetes management and medication use can be affected by religious practices such as fasting during Ramadan. During Ramadan, Muslims refrain from oral or intravenous substances from sunrise to sunset. This may lead to many potential health or medication-related risks for patients with diabetes who observe this religious practice. This literature review aimed to explore (1) health care-related interventions and (2) intentions, perspectives, or needs of health care professionals (HCPs) to provide clinical services to patients with diabetes while fasting during Ramadan with a view to improve health outcomes for those patients.MethodsUsing a scoping review approach, a comprehensive search was conducted. Databases searched systematically included PubMed, Medline, Embase, and International Pharmaceutical Abstracts. Studies published in English that described interventions or intentions to provide interventions regarding diabetes and Ramadan fasting were included.ResultsFourteen published articles that met the inclusion criteria were retrieved and content analyzed. Of those, nine intervention studies regarded diabetes management education. Five studies described professional service intention, four of which were related to the role of pharmacists in diabetes management in Qatar, Australia, and Egypt, and one French study examined the general practitioners’ (GPs) experiences in diabetes management for Ramadan observers. The intervention studies had promising outcomes for diabetes management during Ramadan. Effect sizes for improvement in HbA1c post intervention ranged widely from −1.14 to 1.7. Pharmacists appeared to be willing to participate in programs to help fasting patients with diabetes achieve a safe therapeutic outcome. Service intention studies highlighted pharmacists’ and GPs’ need for training prior to providing services from a clinical as well as cultural competence perspective.ConclusionInterventions research in this area requires robustly designed and structured interventions that can be tested in different contexts. This literature review revealed many gaps regarding diabetes management in Ramadan. Health professionals are willing to provide services for fasting diabetes patients, but need upskilling.

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Diabetes telemonitoring reduces the risk of hypoglycaemia during Ramadan: a pilot randomized controlled study

Abstract: The results of this study reinforce the need for monitoring as well as educational initiatives for Muslims with diabetes who fast during Ramadan. Telemonitoring offers an attractive option requiring further research. (Clinical Trial Registry No. NCT02189135).

Cited by 43 publications

References 7 publications

Fasting in Ramadan with type 1 diabetes: A dose adjustment for normal eating workshop in Kuwait

Fasting in Ramadan with type 1 diabetes: A dose adjustment for normal eating workshop in Kuwait

Telemedicine for the Management of Glycemic Control and Clinical Outcomes of Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

Fasting, Diabetes, and Optimizing Health Outcomes for Ramadan Observers: A Literature Review

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