Management of Diabetes in Individuals with Diabetes who are Fasting During Ramadan

Year 2021, Volume: 5 Issue: 1, 59 - 67, 24.04.2021

Aslı Onur , Zeynep Caferoğlu , Nihal Hatipoğlu

https://doi.org/10.25048/tudod.788391

Cited By: 1

Abstract

Fasting, which is important in many ancient religions, is also one of the basic conditions of Islam. During the month of Ramadan, Muslims do not eat and drink from dawn to sunset. The month of Ramadan continues for 29-30 days and the fasting period ranges from 10 to 20 hours depending on geographic location. The condition for fasting is to be healthy and not have chronic illness. However, with the thought that it is a religious obligation and will provide spiritual benefit, most individuals with chronic diseases also want to fast. Diabetes mellitus (DM) is considered a high risk condition for fasting in Ramadan, as it is a chronic metabolic disease and carries risks such as hypoglycemia and hyperglycemia during fasting. Hypoglycemia is a common problem during fasting during Ramadan. However, in clinical practice, most individuals with DM prefer to fast. Therefore, healthcare professionals must provide training to protect individuals with DM against various risks and to prevent hypoglycemic and hyperglycemic events. This review has been prepared in order for health professionals to make recommendations such as dose adjustment, risk classification, education, pharmacotherapy and blood glucose monitoring, medication and in line with the recommendations of the guidelines for type 1 and type 2 DM adults who plan to fast during Ramadan.

Keywords

Diabetes mellitus, glycemic control, blood glucose monitoring, oral antidiabetic medicine, insulin therapy

Ramazan Ayında Oruç Tutan Diyabetli Bireylerde Diyabetin Yönetimi

Abstract

Diabetes mellitus (DM) kronik metabolik bir hastalık olduğu ve oruç sırasında hipoglisemi, hiperglisemi, dehidratasyon ve koagulasyon gibi riskler taşıdığından Ramazan orucu için riskli bir durum olarak kabul edilir. Ramazan ayı boyunca Müslümanlar, şafaktan gün batımına kadar geçen süre boyunca yiyecekten, içecekten, sigaradan ve cinsel ilişkiden uzak dururlar. Ramazan ayı 29-30 gün sürmekte ve oruç tutulan süre coğrafi konuma göre 10 ila 20 saate kadar uzun bir zaman dilimini kapsamaktadır. Oruç tutmak için şart,
sağlıklı olmak ve kronik hastalığa sahip olmamaktır. Ancak, dini zorunluluk olduğu ve manevi fayda sağlayacağı düşüncesiyle kronik hastalığı olan çoğu birey de oruç tutmayı istemektedir. Ramazan ayında oruç sırasında hipoglisemi korkusu da yaygın bir sorundur. Bununla birlikte, klinik uygulamada DM’li bireylerin çoğu oruç tutmayı tercih etmektedir. Bu nedenle sağlık uzmanlarının çeşitli risklere karşı DM’li bireyleri koruması, hipoglisemik ve hiperglisemik olayları önlemek için bu özel durumlara özgü eğitim vermesi
zorunluluğu kaçınılmazdır. Bu derleme, sağlık uzmanlarının Ramazan ayında oruç tutmayı planlayan tip 1 ve tip 2 DM’li yetişkin bireylere kılavuzların önerileri doğrultusunda risk sınıflandırması, eğitim, farmakoterapi ve kan şekeri takibi, ilaç ve doz ayarlaması gibi önerilerde bulunabilmek için hazırlanmıştır.

Keywords

Diabetes mellitus, glisemik kontrol, kan şekeri takibi, oral antidiyabetik ajan, insülin tedavisi

References

• Lessan N, Ali T. Energy metabolism and intermittent fasting: The ramadan perspective. Nutrients. 2019;11(5).
• Bener, Abdülbari, Al-Hamaq Abdulla OAA ÖA. Effect of ramadan fasting on glycemic control and other essential variables in diabetic patients. Ann Afr Med [Internet]. 2018;17(4):196–202. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330786/
• Bajaj HS, Abouhassan T, Ahsan MR, Arnaout A, Hassanein M, Houlden RL, et al. Diabetes Canada Position Statement for People With Types 1 and 2 Diabetes Who Fast During Ramadan. Can J Diabetes [Internet]. 2019;43(1):3–12. Available from: https://doi.org/10.1016/j.jcjd.2018.04.007
• Grajower MM, Horne BD. Clinical management of intermittent fasting in patients with diabetes mellitus. Nutrients. 2019;11(4):1–11.
• Salti I, Bénard E, Detournay B, Bianchi-Biscay M, Le Brigand C, Voinet C, et al. A population-based 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.
• Hassanein M, Al-Arouj M, Hamdy O, Bebakar WMW, Jabbar A, Al-Madani A, et al. Diabetes and Ramadan: Practical guidelines. Diabetes Res Clin Pract [Internet]. 2017;126:303–16. Available from: http://dx.doi.org/10.1016/j.diabres.2017.03.003
• Tan C, Yong AML, Haji Mohamad MA, Abdul Rahman H, Naing L. Fasting in Ramadan of Muslim patients with diabetes Mellitus, and knowledge and practice in relation to diabetes control in Brunei. Diabetes Res Clin Pract [Internet]. 2018;144:171–6. Available from: https://doi.org/10.1016/j.diabres.2018.09.004
• Ibrahim M, Davies MJ, Ahmad E, Annabi FA, Eckel RH, Ba-Essa EM, et al. Recommendations for management of diabetes during Ramadan: update 2020, applying the principles of the ADA/EASD consensus. BMJ Open Diabetes Res Care. 2020;8(1):1–14.
• Jabbar A, Hassanein M, Beshyah SA, Boye KS, Yu M, Babineaux SM. CREED study: Hypoglycaemia during Ramadan in individuals with Type 2 diabetes mellitus from three continents. Diabetes Res Clin Pract [Internet]. 2017;132:19–26. Available from: http://dx.doi.org/10.1016/j.diabres.2017.07.014
• Malik U, Mahmood N, Khan KA, Hameed M, Randhawa FA, Salman S, et al. Glycaemic Control Of Type 2 Diabetic Patients During Ramazan Fasting. J Ayub Med Coll Abbottabad. 2017;29(1):102–6.
• Rashid F, Abdelgadir E. A systematic review on efficacy and safety of the current hypoglycemic agents in patients with diabetes during Ramadan fasting. Diabetes Metab Syndr Clin Res Rev [Internet]. 2019;13(2):1413–29. Available from: https://doi.org/10.1016/j.dsx.2019.02.005
• 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;29(6):709–15.
• 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.
• Gad H, Al-Muhannadi H, Purra H, Mussleman P, Malik RA. The effect of Ramadan focused education on patients with type 2 diabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract [Internet]. 2020;162:108122. Available from: https://doi.org/10.1016/j.diabres.2020.108122
• Loh HH, Lim LL, Loh HS, Yee A. Safety of Ramadan fasting in young patients with type 1 diabetes: A systematic review and meta-analysis. J Diabetes Investig. 2019;10(6):1490–501.
• Frier BM. Hypoglycaemia in diabetes mellitus: Epidemiology and clinical implications. Nat Rev Endocrinol. 2014;10(12):711–22.
• Eid YM, Sahmoud SI, Abdelsalam MM, Eichorst B. Empowerment-based diabetes self-management education to maintain glycemic targets during ramadan fasting in people with diabetes who are on conventional insulin: A feasibility study. Diabetes Spectr. 2017;30(1):36–42.
• Kaplan W, Afandi B. Blood glucose fluctuation during ramadan fasting in adolescents with type 1 diabetes: Findings of continuous glucose monitoring. Diabetes Care. 2015;38(10):e162–3.