The lunar-based month of Ramadan is currently taking place, in which Muslims refrain from eating, drinking, smoking, and/or taking medications from predawn until sundown. Globally, around 50 million Muslims with diabetes fast during the month of Ramadan each year. During fasting, people with diabetes can have acute complications. The risk increases in non-equatorial countries with longer duration of fasting. Diabetes management becomes even more challenging when Ramadan falls during the summer, as in this year, because the period of food & liquid deprivation is longer and excess heat can induce significant dehydration.

Data from prospective studies regarding fasting are scarce. Recommendations and suggestions from experts depend on personal experiences and evidence based guidelines are missing. In 2012 the Ramadan Prospective Diabetes Study showed lesser complications in fasting people with diabetes with active glucose monitoring, pre-Ramadan specific diabetes education, and alteration in drug dosages and timings before Ramadan. In 2014, a retrospective, cross-sectional survey in 13 Muslim countries revealed 43% of people with type 1 and 79% with type 2 diabetes fast during Ramadan. Lack of Ramadan specific education, glucose monitoring, and lifestyle changes, non-alterations of drug dosages and timing in majority of fasting people with diabetes resulted in reporting of higher rate of complications.

The recently conducted multinational survey in 7 countries with more than 6000 fasting people with diabetes identified education as the cornerstone of safe fasting during Ramadan. Pre-Ramadan structured education should include symptoms of hypo and hyperglycaemia, glucose monitoring, dietary changes and fluid intake, physical activity, drug dosages and timing alteration and when to break the fast.

We would like to invite the D-NET community to express their views and raise any queries regarding handling diabetes during Ramadan, which we shall be happy to address.

How can diabetes be managed during periods of fasting?

Information about the discussion leader

The discussion will be moderated by Prof Abdul Basit (Director of the Baqai Institute of Diabetology & Endocrinology (BIDE) - IDF Centre of Education in Karachi, Pakistan) and Dr Vinod Kundanlal Abichandani (Diabetologist and Head of Department of Diabetes & Endocrine Disorders three hospitals in Ahmedabad, India)

References

1. Al-Arouj M, Assaad-Khalil S, Buse J, Fahdil I, Fahmy M, Hafez S, et al. Recommendations for management of diabetes during Ramadan: update 2010. Diabetes Care. 2010 Aug;33(8):1895–902.

2. Ahmedani MY, Haque MS, Basit A, Fawwad A, Alvi SFD. Ramadan Prospective Diabetes Study: the role of drug dosage and timing alteration, active glucose monitoring and patient education. Diabet Med. 2012 Jun;29(6):709–15.

3. Ahmedani MY, Alvi SFD, Haque MSU, Fawwad A, Basit A. Implementation of Ramadan-specific diabetes management recommendations: a multi-centered prospective study from Pakistan. J Diabetes Metab Disord. 2014;13(1):37.

4. Hakeem R, Ahmedani MY, Alvi SFD, Ulhaque MS, Basit A, Fawwad A. Dietary patterns and glycemic control and compliance to dietary advice among fasting patients with diabetes during Ramadan. Diabetes Care. 2014;37(3):e47–48.