SF | ENDOCRINOLOGY
January 2022 | Vol. 22 No. 1
This article was independently sourced by Specialist Forum.
www.medicalacademic.co.za Photo credit: Shutterstock.com
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Keys to successful diabetes management during Ramadan More than a billion Muslims with diabetes worldwide may choose to fast during Ramadan of which about 10% will develop complications2,3 Ramadan is observed by Muslims worldwide as a month of fasting, prayer, reflection, and community. In 2022 the Holy month of Ramadan starts on the evening of 2 April, lasting 30 days and ending at sundown on 1 May.1
T
he duration of daily fasting ranges from a few hours up to 20 hours, depending on the geographical location and season. Apart from fasting (including drinking), Muslims are also expected to abstain from using oral medications and smoking from predawn to after sunset.1 There are no restrictions on food or fluid intake between sunset and dawn. Most people consume two meals per day during this month, one after sunset, referred to in Arabic as Iftar (breaking of the fast meal), and the other before dawn, referred to as Suhur (predawn).1 Fasting during Ramadan is an obligation for all adult Muslims. However, the Koran specifically exempts the sick from fasting – especially if it might lead to harmful consequences for the individual.
Although patients with diabetes fall under this category because of their chronic disorder, many insist on fasting during Ramadan, creating a medical challenge for themselves and their physicians. It is therefore important that medical professionals are aware of potential risks that may be associated with fasting during Ramadan, and how to manage them.1
Potential risks associated with fasting during Ramadan Patients with diabetes are at risk of major potential complications associated with fasting. These include:1,2,3
Hypoglycaemia Decreased food intake is a well-known risk factor for the development of hypoglycaemia. The Epidemiology of
Diabetes and Ramadan 1422/2001 (EPIDIAR) study showed that fasting during Ramadan increased the risk of severe hypoglycaemia (defined as requiring hospitalisation) some 4.7-fold in patients with type 1 diabetes (T1DM) and ∼7.5-fold in patients with type 2 diabetes (T2DM).2
Hyperglycaemia Long-term morbidity and mortality studies in people with diabetes, such as the Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study, demonstrated the link between hyperglycaemia, microvascular complications, and possibly macrovascular complications.1 The extensive EPIDIAR study showed a ∼5-fold increase in the incidence of severe hyperglycaemia (requiring hospitalisation)
