Safeguarding diabetes patients in Ramadan

Millions of Muslims with diabetes are at risk if they fast during Ramadan without guidance.

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A new review of recent research has issued crucial caveats on fasting during Ramadan for Muslims with type II diabetes.  

Based on the global prevalence of diabetes, an estimated 50 million Muslims around the world have the disease. During the fasting month of Ramadan, Muslims refrain from drinking, eating, using medications or smoking from dawn to dusk. The exact duration of the fast depends on geographical location and the seasons, as the Islamic calendar is a lunar one. In the summers in some countries, fasting can last up to 20 hours a day.  

The ill are usually exempt from the fast, according to Islamic rulings. Still, many Muslims choose to fast against the advice of doctors and religious authorities.  

Researchers from King Fahad Medical City and King Saud bin Abdulaziz University for Health Science in Saudi Arabia reviewed recent studies on type II diabetes in adults.  

According to an Epidemiology of Diabetes and Ramadan (EPIDIAR) study done in 2004 and published in Diabetes Care,78.7% of type II diabetes patients who fast for at least 15 days during Ramadan are 7.5 times more likely to experience low blood glucose, or hypoglycaemia, leading to hospitalization. They are also five times as likely to experience excess in blood glucose, or hyperglycaemia, after eating.   

The population-based EPIDIAR study examined a total of 12,243 patients across 13 countries. It found that fasting increases the risk of both hypoglycaemia and postprandial hyperglycaemia; the latter is a rapid and high increase in blood glucose following the consumption of a large and heavy meal, typical during the breaking of the fast ritual in Ramadan.  

Research reveals that fasting can also lead to dehydration and blood clotting in the circulatory system.  

Exasperating the situation is the decision by some patients to stop taking medication altogether, skipping doses, reducing them, or taking them at closer intervals without medical advice.  

There is also a lack of consensus on the most effective anti-diabetic drug during Ramadan. Some studies mention dipeptidyl peptidase (DPP)-4 inhibitors, enzyme inhibitors affecting metabolic hormones that play a role in insulin secretion and blood glucose regulation. Others cite repaglinide, another agent that works by lowering blood sugar.  

As a result of their research review, the Saudi researchers suggest many medical professionals lack awareness of the patterns of diabetic patients during Ramadan and how to pre-emptively deal with them.  

They recommend some medical and lifestyle interventions to ensure patient safety during the holy month. The interventions include daily blood glucose readings and adequate nutrition.  

Patients should, for instance, be made aware that puncturing the skin with glucose monitoring devices will not affect their ability to fast and is allowed during the fasting hours.  

“All patients with diabetes who wish to fast for Ramadan should receive a proper medical assessment, educational counselling, and appropriate blood testing one to two months before Ramadan to engage in the fast as safely as possible,” write the researchers. They also endorse rigorous meal planning and individualized treatment regimens.  

Those who are not fit to fast should be made aware of the potential risks, they say.

References

  1.  Almalki, M.H. et al. Options for Controlling Type 2 Diabetes during Ramadan. Frontiers in Endocrinology.(2016) | article

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