Ramadan fasting and diabetes, latest evidence and technological advancements: 2021 update

Abstract

Development of updated guidelines for management of diabetes in Ramadan Fasting is of paramount importance. Nonetheless, evidence-based guidelines in the field of Ramadan Fasting and Diabetes are scarce. Moreover, findings of some recent research such as effects of Ramadan fasting on microbiota, genetics and epigenetics, hormonal changes (such as adiponectin, leptin, testosterone…), and alternations in circadian rhythm should also be reviewed and included on a yearly basis. It is documented that self-monitoring of blood glucose (SMBG) is of vital importance for patients with type 1 diabetes who fast, and advantages of continuous glucose monitoring (CGM) or flash glucose monitoring (FGM) techniques should be highlighted. Moreover, the recent findings about applications of advanced insulin delivery technology in patients with diabetes who fast in Ramadan should also considered in the annual updates of the guidelines.

Development and Validation of an Educational Booklet for The Healthy Eating Management of Diabetes Mellitus During Ramadan Fasting

“…People with diabetes require to feel safe and comfortable during Ramadan fasting through education that focuses on Ramadan fasting, pre-Ramadan assessment, balanced nutrition planning, physical activity, and self-monitoring of blood glucose (Khaled, 2014) (Oliveira et al, 2014), (Maideen et al, 2019) (Tootee & Larijani, 2021) were the background for the preparation of this booklet. Education for people with diabetes focusing on Ramadan is focused on increasing knowledge, management, and self-empowerment in making the right decisions about managing conditions during Ramadan (Hassanein et al, 2017).…”

“…by 2024, the number of people with diabetes will reduce in countries with a predominantly Muslim population (Tootee & Larijani, 2021).…”

“…People with diabetes who choose to fast during Ramadan without monitoring blood glucose control, taking the correct medication consumption, managing food intake, and proper exercise regularly could lead to health problems, including hypoglycemia, hyperglycemia, ketosis, and dehydration (Benaji et al, 2006) (Alsafadi et al, 2011), (IDF-DAR, 2016) (Ahmed et al, 2020) (Omar et al, 2020) (Tootee & Larijani, 2021), changes in anthropometry even though there is no alteration in energy intake (Azizi, 2013) (Alsafadi et al, 2011), lipid profile, blood pressure (Ahmed et al, 2020), hypovolemia and thrombosis (Maideen et al, 2019) (Al-Arouj et al, 2010. The incidence of hypoglycemia during fasting increased four times (10.8%) than without fasting (2.7%) (Santosa, 2014).…”

“…The results of Indonesia Basic Health Research (2018) show that 85.5% of people with diabetes never monitor their blood glucose levels, and 12.8% never monitor their blood glucose levels regularly, even though monitoring blood glucose during Ramadan fasting is very important to avoid diabetes complications. Some strategies to create safe and comfortable Ramadan fasting for people with diabetes include education that focuses on Ramadan fasting, pre-Ramadan health checks, balanced nutrition planning, physical activity, and independent blood glucose monitoring (Oliveira et al, 2014), (Maideen et al, 2019) (Tootee & Larijani, 2021). Only as many as 40% of people with diabetes do pre-Ramadan counseling (Alsafadi et al, 2011).…”