Management of diabetes during Ramadan fasting in children and adolescents: A survey of physicians’ perceptions and practices in the Arab Society for Paediatric Endocrinology and Diabetes (ASPED) countries

Elbarbary, Nancy; Deeb, Asma; Habeb, Abdelhadi; Beshyah, Salem A

doi:10.1016/j.diabres.2018.12.014

Cited by 11 publications

(15 citation statements)

References 19 publications

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“…Management of children and adolescents with type 1 diabetes during Ramadan is highly variable in Arab countries 85 and hypoglycemia during daytime fasting remains a major concern. Although the use of CGM may reduce risk of hypoglycemia during Ramadan, 86 the fear of hypoglycemia persists.…”

Section: Children With Type 1 Diabetesmentioning

confidence: 99%

Recommendations for management of diabetes during Ramadan: update 2020, applying the principles of the ADA/EASD consensus

Ibrahim¹,

Davies

Ahmad

et al. 2020

BMJ Open Diab Res Care

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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.

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Section: Children With Type 1 Diabetesmentioning

confidence: 99%

Recommendations for management of diabetes during Ramadan: update 2020, applying the principles of the ADA/EASD consensus

Ibrahim¹,

Davies

Ahmad

et al. 2020

BMJ Open Diab Res Care

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“…With the management of diabetes during Ramadan fasting in children and adolescents in mind, an online survey of physicians' perceptions and practices in the Arab Society for Pediatric Endocrinology and Diabetes (ASPED) countries revealed gaps in knowledge, perceptions, and practices. [50] This was not much different from the knowledge gaps found in physicians charged with the care of adults with diabetes detected in a previous survey. [51] .…”

Section: Future Directionsmentioning

confidence: 59%

Ramadan fasting and diabetes in adolescents and children: A narrative review

Beshyah

Habeb

Deeb

et al. 2019

Ibnosina Journal of Medicine and Biomedical Sciences

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Review Article introduCtionRamadan fasting is one of the cardinal articles of Islam commonly known as "the five Pillars of Islam". [1,2] Fasting is obligatory for all healthy adult and adolescent Muslims. [1,2] Fasting is ordained from the time of completing the puberty which varies from 12 to 16 years of age. Fasting starts from early dawn (Sohur) to sunset (Iftar). During this period, a fasting person has to abstain from eating and drinking. Islam has allowed many categories of people to be exempted from fasting, for example, prepubertal children, travelers, the sick, the elderly, pregnant, and lactating women and individuals with chronic illnesses such as type 1 diabetes mellitus (T1DM).Sick individuals and children are exempted from fasting Ramadan. However, many patients insist on following the fast, often without the approval of their physicians. [3,4] Ramadan fasting represents a significant shift in meal timing and content for practicing Muslims. This naturally affects the bodily homeostasis, metabolic environment, fluid balance, and interaction of foods, drugs, and disease.Fasting by T1DM patients might predispose to acute complications due to the loss of fine balance between insulin action and carbohydrate supply in different directions in the two different times of the fasting cycle. [5] . The global literature production on health aspects of Ramadan fasting is notably relatively low in general as shown in recent review of the whole of publications in one year (2017) [6] . Similarly, a more focused recent bibliometric analysis quantified the global production on Ramadan and diabetes over the last three decades also showed a low volume of scholarly work. [7] There are several review articles and clinical practice guidelines in general with a predictable emphasis on adults. [8][9][10][11][12] However, there are no comprehensive guidelines specifically addressing Although children in general and patients with type 1 diabetes mellitus, in particular, are exempted from fasting during Ramadan, many elect to observe the fast. There is a sizeable amount of opinion and research data that warrants revisiting. This is a narrative nonsystematic review to explore the views and supporting data on Ramadan fasting and to examine the safety of fasting and its impact on diabetes control and management in children and adolescents. The key areas covered include epidemiology, the physiology of fasting, risk stratification, counseling strategy, nutrition advice, insulin therapy adjustment with a particular focus on multiple injection regimen, and insulin pump therapy. Findings from various studies and expert opinions were appraised and presented to illustrate points of agreements and differences. This review should enhance knowledge and form the basis to clear some doubts and differences of opinions surrounding the issue of diabetes and Ramadan fasting in young people. It should also empower healthcare professionals to develop consensus based on the most up-to-date advice and the best possible support to patients and famili...

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“…This approach has proven successful in our region in producing meaningful data. [18,19]. We are cognizant of the notion that the sample size may have been smaller than expected but despite our best attempts.…”

Section: Discussionmentioning

confidence: 94%

“…However, many survey-based studies from our and other groups were of similar size, yet they were considered valid . [18,19] Notwithstanding, we are not complacent about this as larger sample sizes do produce better quality data and are encouraged in future studies.…”

Section: Discussionmentioning

confidence: 99%

Knowledge gaps and perceptions of future research directions on management of diabetes during Ramadan fasting: An online survey of physicians

Beshyah

Ali

Hajjaji

et al. 2021

Diabetes Research and Clinical Practice

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Management of diabetes during Ramadan fasting in children and adolescents: A survey of physicians’ perceptions and practices in the Arab Society for Paediatric Endocrinology and Diabetes (ASPED) countries

Cited by 11 publications

References 19 publications

Recommendations for management of diabetes during Ramadan: update 2020, applying the principles of the ADA/EASD consensus

Recommendations for management of diabetes during Ramadan: update 2020, applying the principles of the ADA/EASD consensus

Ramadan fasting and diabetes in adolescents and children: A narrative review

Knowledge gaps and perceptions of future research directions on management of diabetes during Ramadan fasting: An online survey of physicians

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