<scp>ISPAD</scp>
            Clinical Practice Consensus Guidelines 2022: Ramadan and other religious fasting by young people with diabetes

Deeb, Asma; Babiker, Amir; Sedaghat, Sara; Awwa, Ahmed El; Gupta, Kowshik; Pulungan, Aman B; Umar, Umar Isa; Akanov, Zhanay; Kalra, Sanjay; Zangen, David; Adhami, S H; Karipidou, Melina; Marcovecchio, M. Loredana

doi:10.1111/pedi.13447

Cited by 7 publications

(8 citation statements)

References 137 publications

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“…Two updated sets of clinical practice guidelines were published in 2022. 41 42 The IDF and DAR International Alliance have substantially updated the previous guidelines. 41 This update includes key information on fasting during Ramadan with T1DM, the management of diabetes in people of elderly ages and pregnant women, the effects of Ramadan on one's mental well-being, changes to the risk of macrovascular and microvascular complications, and areas of future research.…”

Section: Resultsmentioning

confidence: 99%

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Ramadan Fasting and Diabetes (2022): The Year in Review

Hafidh

Besheya

Elmehdawi

et al. 2023

Journal of Diabetes and Endocrine Practice

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Objectives The literature on the impact of Ramadan fasting (RF) on metabolic control and health in people with diabetes is widely spread in many journals making it not readily accessible to those interested in the subject. We aimed to provide a narrative overview of the global literature production in 1 year (2022) on diabetes and RF. Materials and Methods It is a narrative, non-systematic review of the international literature from a single major medical online database (i.e., PubMed) in one calendar year (2022). Relevant literature was narrated in a concise thematic account. Results Themes emerged from the review of the literature on RF published in 2022, including a couple of studies on the epidemiology of fasting in the real world by adults and children. Three studies involved some pathophysiological observations of metabolic and other biochemical markers. Several studies assessed the use and safety of different pharmacological therapeutic agents. Certain sulfonylureas, such as modified-release gliclazide, were considered safer than other sulfonylureas. Newer basal insulin analogs were studied in different geographical and socioeconomic settings (Gulf vs. South East Asia). The role of diabetes technology in Ramadan was the focus of several studies of insulin pumps and monitoring. Special themes were high-risk groups, pregnancy, acute complications, postbariatric surgery, and COVID-19 in Ramadan. Few studies examined the safety of sodium-glucose co-transporter-2 inhibitors as a class and individually during RF. Professional and patient perspectives released in 2022 included updated guidelines for adults and adolescents. Conclusions In 2022's medical literature, RF and diabetes continue to address epidemiology, the burden of diabetes care on fasting patients, and discussions of concerns of patients and healthcare professionals. Risk stratification and issues of high-risk patients are still in focus for children, adolescents, and adults. Approaches to effective management still gather evidence for newer pharmacological agents and diabetes technology.

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Section: Resultsmentioning

confidence: 99%

“…Moreover, they also included another religious fasting by young people with diabetes. 42 These guidelines seek to improve the awareness, knowledge, and management of diabetes during Ramadan and to provide real-world recommendations to health professionals and the people with diabetes who choose to fast.…”

Section: Resultsmentioning

confidence: 99%

Ramadan Fasting and Diabetes (2022): The Year in Review

Hafidh

Besheya

Elmehdawi

et al. 2023

Journal of Diabetes and Endocrine Practice

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“…Most international societies and associations consider T1D a high or very high-risk condition for fasting due to the increased risk of dehydration, hypoglycemia, and hyperglycemia [ 3 , 55 , 56 ]. Moreover, fasting accelerates lipolysis, ketosis, and glucagon levels, which accounts for the increased risk of developing diabetic ketoacidosis (DKA) [ 57 , 58 ].…”

Section: Methodsmentioning

confidence: 99%

“…Hence, poorly controlled people with T1D, with or without the presence of comorbidities or complications, are widely recognized as a very high-risk group who must abstain from fasting during Ramadan, while those well-controlled are recognized as a high-risk group, who should be advised not to fast during Ramadan [ 13 ]. For individuals who insist on fasting, frequent SMBG or CGM is advised during fasting to reduce hypo/hyperglycemic episodes and warn the patient to break fasting [ 55 ]. In addition, real-time monitoring of blood glucose fluctuations through CGM can help in informing dose adjustment strategies during Ramadan [ 3 ].…”

Section: Methodsmentioning

confidence: 99%

“…Insulin type, dosage, and timing may need to be modified to minimize possible risks during Ramadan fasting. Patients who insist on fasting should be offered an individualized meal plan to ensure an adequate balanced diet during Ramadan and educated to use proper carbohydrate counting for meals to match the insulin dose [ 55 ]. It has to be stressed that people with T1D with good metabolic control using an insulin pump and/or CGM with compliance, strict follow-up, and time-in-range of 70% or more can be classified as moderate-risk and can fast with caution under medical supervision, as previously recommended [ 55 ].…”

Section: Methodsmentioning

confidence: 99%

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Risk Stratification in People with Diabetes for Fasting During Ramadan: Consensus from Arabic Association for the Study of Diabetes and Metabolism

Shaltout,

Abdelwahab,

El Meligi

et al. 2024

CDR

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Background: Current international guidelines recommend a pre-Ramadan risk assessment for people with diabetes (PwDM) who plan on fasting during the Holy month. However, a comprehensive risk assessment-based recommendation for the management of PwDM intending to fast is still controversial. Therefore, the Arabic Association for the Study of Diabetes and Metabolism (AASD) developed this consensus to provide further insights into risk stratification in PwDM intending to fast during Ramadan. Methods: The present consensus was based on the three-step modified Delphi method. The modified Delphi method is based on a series of voting rounds and in-between meetings of the expert panel to reach agreements on the statements that did not reach the consensus level during voting. The panel group comprised professors and consultants in endocrinology (both adult and pediatric). Other members included experts in the fields of cardiovascular medicine, nephrology, ophthalmology, and vascular surgery, affiliated with academic institutions in Egypt. Result: In PwDM who intend to fast during Ramadan, risk stratification is crucial to optimize patient outcomes and prevent serious complications. The present consensus provides risk assessment of those living with diabetes according to several factors, including the type of diabetes, presence, and severity of complications, number of fasting hours, and other socioeconomic factors. According to their risk factors, patients were classified into four categories (very high, high, moderate, and low risk). Conclusion: Future research is warranted due to the controversial literature regarding the impact of fasting on certain comorbidities.

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