Evaluation of glycaemic control and diabetes treatment strategies during the religious fasting period of Ramadan

Abstract

Ramadan is one of the longest periods of religious fasting. Muslims abstain from food and drink from sunrise to sunset for the month of Ramadan. In patients with diabetes, dietary changes during Ramadan can influence the glycaemic control. Since Ramadan is a key part of the Islamic faith, many Muslims with diabetes are willing to endure the hardship and choose to fast. The thesis included discussions on the physiology and the practice of fasting in different religious groups. The current evidence for the optimum diabetes management during Ramadan was reviewed and recommendations were made based on randomised, comparison and observational studies and expert consensus. The practice of fasting among pregnant women with diabetes was assessed in North West London in a questionnaire-based survey. Only 10% of women fasted. Having diabetes and hypoglycaemia were the likely deterrent factors. Imams (religious advisors) were as important as healthcare professionals in advising about fasting. The glycaemic variability in patients with diabetes who followed the recommendations for optimal diabetes management was studied using continuous glucose monitoring. The glycaemic variability during fasting and non-fasting periods of Ramadan was similar, suggesting that pre-Ramadan assessment was useful in negating glycaemic excursions during Ramadan. Changing to Humalog Mix 50 insulin at Iftar (sunset meal) in type 2 diabetes patients that were on twice daily Human Mixtard 30 insulin minimised their risk of hypoglycaemia without compromising their glycaemic control during Ramadan. The incretin-based therapies were more suitable than gliclazide when considering an add-on to metformin for type 2 diabetes patients who planned to fast for Ramadan. In summary, the main aim of pre-Ramadan assessment and therapeutic adjustments is to allow patients with type 2 diabetes to fast safely during Ramadan.