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.