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Education, support needed for Ramadan fasting with diabetes
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Muslim adults with diabetes considering fasting during the holy month of Ramadan face several health risks that must be addressed, including hypoglycemia, hyperglycemia, dehydration and thrombosis, according to a recent analysis.
In an overview of evidence for the best clinical management of type 1 and type 2 diabetes during Ramadan, researchers noted that most Muslims with diabetes often do not consider themselves unwell and exempted from fasting, and run higher risks for adverse health complications.
“In our experiences, most people do not appreciate the implications of Ramadan fasting on their diabetes, and that these risks are greater when the fast is prolonged,” Simak Ali, PhD, professor of molecular endocrine oncology at Imperial College London, and colleagues wrote. “If patients are provided with good education and support, they will be able to make informed decisions about whether to fast.”
Researchers recommended that patients with diabetes consult with their physician at least 1 to 2 months before Ramadan, when possible, to discuss optimal diabetes self-management. In one observational study cited by the researchers, patients with type 2 diabetes who did not receive structural education and went on to fast during Ramadan were four times more likely to experience hypoglycemia; those who received pre-Ramadan education experienced a 50% reduction in hypoglycemia and lost a small amount of weight. Researchers recommended that patients with type 1 diabetes not fast, due to risks for hypoglycemia, hyperglycemia and diabetic ketoacidosis (DKA).
“There will be individuals who fast despite medical advice,” the researchers wrote. “As this represents personal choice, it is imperative to support those who chose to fast to ensure they do so safely.”
Patients planning to fast should be provided with a means to test their blood glucose, including those who normally do not test, the researchers noted. All glucose-lowering medications should also be reviewed, with dose adjustments made were necessary. There is no clinical evidence available for the use of sodium-glucose cotransporter 2 inhibitors during Ramadan; researchers recommended they be used with caution and that patients drink at least 2 L of water daily to reduce the risk for dehydration. These patients should also test ketones frequently to monitor for DKA.
Wasim Hanif
“Ramadan fasting is an important article of faith and cultural practice among Muslims,” Wasim Hanif, MD, MBBS, FRCP, professor of diabetes and endocrinology, consultant physician and head of service in diabetes at University Hospital Birmingham, U.K., told Endocrine Today. “All Muslim patients with diabetes should be asked about fasting during Ramadan. If they are intending to fast, the risk should be assessed and discussed. Where necessary, appropriate advice on diet, exercise, blood monitoring, breaking fast and alteration of medication should be offered.”– by Regina Schaffer
For more information:
Wasim Hanif, MD, MBBS, FRCP, can be reached at University Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2WB, United Kingdom; Email: wasim.hanif@uhb.nhs.uk.
Disclosure: One researcher reports receiving consulting and speaking fees, grants for investigator-initiated trials or serving on advisory boards for AstraZeneca, Boehringer Ingelheim, Janssen, Lilly, Merck Sharp & Dohme, Mitsubishi Tanabe Pharma Corp., Novo Nordisk, Sanofi-Aventis and Takeda Pharmaceuticals International.
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