MANAGEMENT OF DIABETES IN RAMADAN
AbstractRamadan, the ninth month of Islamic calendar brings alongwith it a sense of responsibility to fast among the Muslim adult population. Though patients with chronic illnesses like Diabetes mellitus are exempted from fasting during the month if their health does not allow, they still wish to fast. This creates a challenge for the health care professionals to enable the patients with Diabetes mellitus to fast safely, without developing complications like hypoglycemia, hyperglycemia, ketoacidosis and thrombosis. This article has reviewed multiple articles published over last two decades to develop a consensus plan regarding management of Diabetes mellitus in Ramadan. Insulin sensitizers are a better option than drugs increasing secretion of insulin. Type 2 Diabetic patients can fast much safely as compare to Type 1 Diabetics.Keywords: Diabetes mellitus; Ramadan; Fasting; Hypoglycaemia; Hyperglycaemia; Ketoacidosis; Insulin
Beshyah SA. Fasting during the month of Ramadan for people with diabetes: Medicine and Fiqh united at last. Ibnosina J Med Biomed Sci 2009;1(2):58–60.
American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2015;38(Suppl 1):S1–93.
Al-Faris EA. Guidelines for the management of diabetic patients in the health centres of Saudi Arabia. J Family Community Med 1997;4(1):12–23.
Salti I, Benard E, Detournay B, Bianchi-Biscay M, Le Brigand C, Voinet C, et al. A Population-base study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: Results of the Epidemiology of Diabetes and Ramadan 1422⁄2001 (EPIDIAR) study. Diabetes Care 2004;27(10):2306–11.
Rashed AH. The fast of Ramadan. Br Med J 1992;304(6826):521–2.
Uysal A, Erdogan MF, Sahin G, Kamel N, Erdogan G. Clinical and metabolic effects of fasting in 41 type 2 patients during Ramadan. Diabetes Care 1998;21(11):2033–4.
Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis: Epidemiology, pathophysiology and management. J Am Med Asso 2000;287(19):2570–81.
Akhan G, Kutluhan S, Koyuncuoglu HR. Is there any change in stroke incidence during Ramadan? Acta Neurol Scandin 2000;101(4):259–61.
Alghadyan AA. Retinal vein occlusion in Saudi Arabia: Possible role of dehydration. Ann Ophthalmol 1993;25(10):394–8.
Temizhan A, Donderici O, Ouz D, Demirbas B. Is there any effect of Ramadan fastingon acute coronary heart disease events? Int J Cardiol1999;70(2):149–53.
Bakiner O, Ertorer ME, Bozkirli E, Tutuncu NB, Demirag NG. Repaglinide plus single-dose insulin glargine: A safe regimen for low-risk type 2 diabetic patients who insist on fasting in Ramadan. Acta Diabetol 2009;46(1):63–5.
Cesur M, Corapcioglu D, Gursoy A, Gonen S, Ozduman M, Emral R, et al. A comparison of glycemic effects of glimepiride, repaglinide and insulin glargine in type 2 diabetes mellitus during Ramadan fasting. Diabetes Res Clin Pract 2007;75(2):141–7.
Al-Arouj M, Bouguerra R, Buse J, Hafez S, Hassanein M, Ibrahim MA, et al. American Diabetes Association recommendations for management of diabetes during Ramadan. Diabetes Care 2005;28(9):2305–11.
Bravis V, Hui E, Salih S, Mehar S, Hassanein M, Devendra D. Ramadan education and awareness in diabetes programme for Muslims with type 2 diabetes who fast during Ramadan. Diabetes Med 2010;27(3):327–31.
International Meeting on Diabetes and Ramadan Recommendations: Edition ofthe Hassan II Foundation for Scientific andMedical Research on Ramadan. Casablanca, Morocco, FRSMR, 1995
Mojaddidi M, Hassanein M, Malik R. Ramadan and diabetes: Evidence-based guidelines. Prescriber 2006;17(17):38–41.
Benaji B, Mounib N, Roky R, Aadil N, Houti IE, Moussamih S, et al. Diabetes and Ramadan: Review of the literature. Diabetes Res ClinPract 2006;73(2):117–25.
NHS. Muslim Spiritual Care Division in the NHS. Ramadan Health Factsheet 2009. [Internet]. [cited 2017 Jul]. Available form: http://www.bmj. com/content/340/bmj.c3053.full
National Institute for Health and Clinical Excellence. Type 2 diabetes—newer agents (partial update of CG66). (Clinical guideline 87) 2009. [Internet]. [cited 2017 Aug]. Available from: http://guidance.nice.org.uk/CG87
Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352(9131):854–65.
Bolen S, Feldman L, Vassy J, Wilson L, Yeh HC, Marinopoulos S, et al. Systematic review: Comparative effectiveness and safety of oral medications for type 2 diabetes mellitus. Ann Intern Med 2007;147(7):386–99.
Rosak C, Mertes G. Effects of acarbose on proinsulin and insulin secretion and their potential significance for the intermediary metabolism and cardiovascular system. Curr Diabetes Rev 2009;5(3):157–64.
Pan C, Yang W, Barona JP, Wang Y, Niggli M, Mohideen P, et al. Comparison of vildagliptin and acarbose monotherapy in patients with type 2 diabetes: A 24-week, double-blind, randomized trial. Diabetes Med 2008;25(4):435–41.
Mafauzy M. Repaglinide versus glibenclamide treatment of type2 diabetes during Ramadan fasting. Diabetes Res Clin Pract 2002;58(1):45–53.
Sari R, Balci MK, Akbas SH, Avci B. The effects of diet, sulfonylureaand repaglinide therapy on clinical and metabolic parameters in type 2 diabetic patients during Ramadan. Endocr Res 2004;30(2):169–77.
Belkhadir J, el-Ghomari H, Klocker N, Mikou A, Nasciri M, Sabri M. Muslims with non-insulin-dependent diabetes fasting during Ramadan: Treatment with glibenclamide. BMJ 1993;307(6899):292–5.
Glimepiride in Ramadan (GLIRA) Study Group. The efficacy and safety of glimepiride in the management of type 2 diabetes in Muslim patients during Ramadan. Diabetes Care 2005;28(2):421–2.
Anwar A, Azmi KN, Hamidon BB, Khalid BA. An open label comparative study of glimepiride versus repaglinide in type 2 diabetes mellitus Muslim subjects during the month of Ramadan. Med J Malaysia 2006;61(1):28–35.
Devendra D, Gohel B, Bravis V, Hui E, Salih S, Mehar S, et al. Vildagliptin therapy and hypoglycemia in Muslim type 2 diabetes patients during Ramadan. Int J Clin Pract 2009;63(10):1446–50.
Vasan S, Thomas N, Bharani AM, Abraham S, Job V, John B, et al. A double-blind, randomized, multicentre study evaluating the effects of pioglitazone in fasting Muslim subjects during Ramadan. Int J Diabetes Dev Ctries 2006;26:70–6.
Norris SL, Lee N, Thakurta S, Chan BKS. Exenatide efficacy and safety: A systematic review. Diabetes Med 2009;26(9):837–46.
Bravis V, Hui E, Salih S, Hassanein M, Devendra D. A comparative analysis of exenatide and gliclazide during the month of Ramadan. Diabetic Med 2010;27:130–5.
Mattoo V, Milicevic Z, Malone JK, Schwarzenhofer M, Ekangaki A, Levitt LK, et al. A comparison of insulin lispro Mix25 and human insulin 30/70 in the treatment of type 2 diabetes during Ramadan. Ramadan Study Group. Diabetes Res Clin Pract 2003;59(2):137–43.
Hui E, Bravis V, Salih S, Hassanein M, Devendra D. Comparison of Humalog Mix 50 with human insulin Mix 30 in type 2 diabetes patients during Ramadan. Int J Clin Pract 2010;64(8):1095–9.
Metzger BE, Lowe LP, Dyer AR, Trimble ER, Charovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008;358(19):1991–2002.
Azar ST, Khairallah WG, Merheb MT, Zantout MS, Fliti F. Insulin therapy during Ramadan fast for patients with type 1 diabetes mellitus. J Med Liban 2008;56(1):46.
Kadiri A, Al-Nakhi A, El-Ghazali S, Jabbar A, Al Arouj M, Akram J, et al. Treatment of type 1 diabetes with insulin lispro during Ramadan. Diabetes Metab 2001;27(4 Pt 1):482–6.
International Diabetes Federation Guideline Development Group. Global guideline for type 2 diabetes. Diabetes Res Clin Pract 2014;104:1–52.
Nasli-Esfahani E, Peimani M, Rambod C, Omidvar M, Larijani B. Developing a clinical diabetes guideline in diabetes research network in Iran. Iran J Public Health 2014;43(6):713–21.
Bravis V, Hui E, Salih S, Mehar S, Hassanein M, Devendra D. Ramadan Education and Awareness in Diabetes (READ) programme for Muslims with Type 2 diabetes who fast during Ramadan. Diabet Med 2010;27(3):327–31.
Masood SN, Sheikh MA, Masood Y, Hakeem R, Shera AS. Beliefs of people with diabetes about skin prick during Ramadan fasting. Diabetes Care 2014;37(4):68–9.
Vasan SK, Karol R, Mahendri NV, Arulappan N, Jacob JJ, Thomas N. A prospective assessment of dietary patterns in Muslim subjectswith type 2 diabetes who undertake fasting during Ramadan. Indian J Endocrinol Metab 2012;16(4):552–7.
Babineaux SM, Toaima D, Boye KS, Zagar A, Tahbaz A, Jabbar A, et al. Multi-country retrospective observational study of the management and outcomes of patients with Type 2 diabetes during Ramadan in 2010 (CREED). Diabet Med 2015;32(6):819–28.
Viskaal-van Dongen M, Kok FJ, de Graaf C. Eating rate of commonly consumed foods promotes food and energy intake. Appetite 2011;56(1):25–31.
Lawton J, Ahmad N, Hanna L, Douglas M, Hallowell N. ‘I can’t do any serious exercise’: barriers to physical activity amongstpeople of Pakistani and Indian origin with Type 2 diabetes. Health Educ Res 2006;21(1):43–54.
Gaborit B, Dutour O, Ronsin O, Atlan C, Darmon P, Gharsalli R, et al. Ramadan fasting with diabetes: An interview study of inpatients’and general practitioners’ attitudes in the South of France. Diabetes Metab 2011;37(5):395–402.
Peeters B, Mehuys E, Van Tongelen I, Van Bever E, Bultereys L, Avonts D, et al. Ramadan fasting and diabetes: An observational study among Turkish migrants in Belgium. Prim Care Diabetes 2012;6:293–6.
Wilbur K, Al Tawengi K, Remoden E. Diabetes patient management by pharmacists during Ramadan. BMC Health Serv Res 2014;14:117.
Amin ME, Chewning B. Community pharmacists’ knowledge of diabetes management during Ramadan in Egypt. Int J Clin Pharm 2014;36(6):1213–21.
Holt RI, Nicolucci A, Kovacs Burns K, Escalante M, Forbes A, Hermanns N, et al. Diabetes Attitudes, Wishes and Needs second study (DAWN2): Cross-national comparisons on barriers and resources for optimal care - Healthcare professional perspective. Diabet Med 2013;30(7):789–98.
Hassanein M. Ramadan focused diabetes education; A much needed approach. J Pak Med Assoc 2015;65(5 Suppl 1):S76–8.
Tripp-Reimer T, Choi E, Kelley LS, Enslein JC. Cultural barriers to care: Inverting the problem. Diabetes Spectr 2001;14:13–22.
Hollinger-Smith, L. Diversity and cultural competency in health care settings. [Internet]. 2016 [cited 2016 Feb 26]. Available at: https://www.ecald.com/assets/Resources/Diversity-and-Cultural-Competency.pdf
Niazi AK, Kalra S. Patient centred care in diabetology: An Islamic perspective from South Asia. J Diabetes Metab Disord 2012;11(1):30.
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