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Aljahdali A, Al-Maiman R, Al-Orf S, Bawazeer N. Impact of Ramadan Fasting on Cardiometabolic and InflammatoryBiomarkers among Saudi Adults with Diabetes. Curr Diabetes Rev 2024; 20:e080124225329. [PMID: 38192134 DOI: 10.2174/0115733998274064231114075657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/02/2023] [Accepted: 09/15/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND AND AIMS Diabetes is prevalent in Saudi Arabia. As dietary concerns are central in patients with diabetes, the impact of fasting on health during Ramadan is potentially significant. Decreased meal frequency and changes in food type and amount affect body weight and metabolic profiles. This study aimed to investigate the association between Ramadan fasting and anthropometric measurements and cardiometabolic and inflammatory biomarkers in Saudi adults with diabetes. METHODS Sixty-eight Saudi adults with diabetes, admitted at the University Diabetes Centre in Riyadh, Saudi Arabia, were enrolled in this study. Participants were evaluated at the following time points: Six weeks before Ramadan (pre-fasting) and at least 15 days after the initiation of Ramadan (peri-fasting). Anthropometric measurements and cardiometabolic and inflammatory biomarker levels were assessed during both visits. RESULTS After accounting for confounding factors, Ramadan fasting was found to be associated with reduced body weight (kg), waist circumference (cm), and hip circumference (cm). Increased log high-density lipoprotein-cholesterol and decreased log interleukin 6 and C-reactive protein levels were observed. CONCLUSIONS Ramadan fasting was associated with increased HDL-C levels and decreased anthropometric measurements and inflammatory cytokine levels. These results support the beneficial role of Ramadan fasting in reducing cardiometabolic abnormalities and inflammation in adults with diabetes.
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Affiliation(s)
- Abeer Aljahdali
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Reham Al-Maiman
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Saada Al-Orf
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Nahla Bawazeer
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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2
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Ali SH, Lin NF, Yi SS. Challenging Dietary Research Measures, Concepts, and Definitions to Promote Greater Inclusivity of Immigrant Experiences: Considerations and Practical Recommendations. J Acad Nutr Diet 2023; 123:1533-1540. [PMID: 37348677 PMCID: PMC10592485 DOI: 10.1016/j.jand.2023.06.280] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Shahmir H Ali
- Department of Population Health, New York University Grossman School of Medicine, New York, NY.
| | - Nelson F Lin
- Department of Population Health, New York University Grossman School of Medicine, New York, NY; Brown University, Providence, RI
| | - Stella S Yi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
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3
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Tootee A, Bandarian F, Namazi N, Atlasi R, Larijani B. Ramadan fasting and type 1 diabetes: a scoping review protocol. BMJ Open 2023; 13:e058847. [PMID: 36914196 PMCID: PMC10016270 DOI: 10.1136/bmjopen-2021-058847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION Ramadan fasting is globally observed and a great majority of the residents of Islamic countries and elsewhere fast during Ramadan all across the world every year. Many patients with type 1 diabetes fast during Ramadan according to (or against) medical and jurisprudence advice. Nonetheless, there is a paucity of scientific evidence regarding the risks patients with diabetes who fast may be confronted with. The current scoping review protocol aims at systematic analysis and mapping of existing literature in the field and highlighting scientific gaps. METHODS AND ANALYSES This scoping review will be conducted based on the Arksey and O'Malley's methodological framework with consideration of later modifications and amendments. Three major scientific databases, namely PubMed, Scopus and Embase up to February 2022 will be systematically searched by expert researchers in collaboration with a medical librarian. Considering the fact that Ramadan Fasting is a cultural-dependent subject, which may be studied in the Middle Eastern and Islamic Countries in languages other than English, local Persian and Arabic Databases will also be included. Grey literature will be sought too, and unpublished works such as conference proceedings and academic degree dissertation will be considered. Subsequently, one author will screen and record all abstracts, and two reviewers will independently screen and retrieve eligible full texts. A third reviewer will then be designated to resolve potential discrepancies. Standardised data charts and forms will be used for information extraction and reporting of the outcomes. ETHICS AND DISSEMINATION No ethical considerations apply to this research. Results will be published and presented in academic journals and scientific events.
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Affiliation(s)
- Ali Tootee
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Fatemeh Bandarian
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular- Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Nazli Namazi
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rasha Atlasi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences School of Medicine, Tehran, Iran (the Islamic Republic of)
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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El-Taravi Y, Baimukhambetova DV, Gorlenko CL, Kiseljow HY, Kokhanovskaia II, Burotina AI, Rassadina ES, Martirosian NS, Petunina NA. Management of diabetes during Ramadan: an update for Russian-speaking doctors. DIABETES MELLITUS 2023. [DOI: 10.14341/dm12972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Fasting during the Islamic Ramadan month is one of the five obligatory pillars for each adult, healthy, and sane Muslim. People with severe illnesses, including type 1 and type 2 diabetes mellitus are exempt from fasting. However, many Muslims often insist on Ramadan participating despite any medical advises. It’s known that Muslims are the second largest religious group in Russia; thus, its crucial to have as much modern recommendation for management patients with type 1 and type 2 diabetes mellitus as possible. The aim of this narrative review is to evaluate physiological and pathophysiological metabolism changing during holy Ramadan month, to clarify the management of patients with type 1 and type 2 diabetes mellitus during Ramadan, to determine the frequency of glucose measuring during the day, and to understand when its time to interrupt the fasting. Moreover, we discuss specific recommendations in glucose-lowering therapy changing, nutrition, physical activities and education.
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Affiliation(s)
- Y.A. El-Taravi
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | - C. L. Gorlenko
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - H. Yu. Kiseljow
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | - A. I. Burotina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - E. S. Rassadina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - N. S. Martirosian
- I.M. Sechenov First Moscow State Medical University (Sechenov University); L.A. Vorokhobov City Clinical Hospital No. 67
| | - N. A. Petunina
- I.M. Sechenov First Moscow State Medical University (Sechenov University); L.A. Vorokhobov City Clinical Hospital No. 67
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5
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Deeb A, Babiker A, Sedaghat S, El Awwa A, Gupta K, Pulungan AB, Isa Umar U, Akanov Z, Kalra S, Zangen D, Al Adhami S, Karipidou M, Marcovecchio ML. ISPAD Clinical Practice Consensus Guidelines 2022: Ramadan and other religious fasting by young people with diabetes. Pediatr Diabetes 2022; 23:1512-1528. [PMID: 36537522 DOI: 10.1111/pedi.13447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Asma Deeb
- Paediatric Endocrinology Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates.,College of Health & Science, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Amir Babiker
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah Specialized Children's Hospital, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Sara Sedaghat
- Department of Diabetes Education, Research and Development, Gabric Diabetes Education Association, Tehran, Iran
| | - Ahmed El Awwa
- Pediatric Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Kowshik Gupta
- Paediatric Endocrinology Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Aman Bhakti Pulungan
- Pediatric Department, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Umar Isa Umar
- Department of Paediatrics, Bayero University Kano, Kano, Nigeria
| | - Zhanay Akanov
- Centre of Diabetes, Kazakh Society for Study of Diabetes, Almaty, Republic of Kazakhstan
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - David Zangen
- Division of Pediatric Endocrinology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sara Al Adhami
- Endocrinology department, Mediclinic City hospital, Dubai, United Arab Emirates
| | - Melina Karipidou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - M Loredana Marcovecchio
- Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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6
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Roky R, Aadil N, Krami AM, Benaji B, Errabih I, Abdelrahim DN, Faris ME. Sex as a Biological Factor in the Changes in Disease Patients During Ramadan Intermittent Fasting: A Systematic Review. Front Nutr 2022; 9:908674. [PMID: 35845800 PMCID: PMC9284209 DOI: 10.3389/fnut.2022.908674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background During Ramadan, many patients with diabetes, renal, cardiovascular, gastrointestinal diseases, headaches, and epilepsy choose to fast even against their doctor's advice. The impact of this intermittent fasting on health and disease could be different in men and women. The aim of this study was to determine the effect of sex as a factor in diseases outcomes of patients who opt to fast during Ramadan. Main Body The articles included in this study reported data on six diseases: diabetes, renal, cardiovascular, gastrointestinal diseases, headaches, and epilepsy. A systematic search was performed on PubMed and Scopus for observational and clinical studies mentioning Ramadan, diabetes, renal, cardiovascular, gastrointestinal diseases, headaches, and epilepsy in both men and women. Data was extracted by two independent reviewers using a standardized data-collection form. From 381 original articles, 38 studies were selected, including 25,023 patients of which 44.4% were women. Sex-based differences were reported by 18 studies for several variables such as body mass index, blood glucose, the frequency of hypoglycemia, renal colic, mortality, thrombosis, and gastrointestinal diseases in patients fasting during Ramadan. Most of the differences between men and women were reported both in the baseline period before Ramadan and during Ramadan. Indeed, during the period outside Ramadan, the frequency of renal colic, cardiovascular, gastrointestinal diseases, were higher in men; while body mass index, Thrombosis, and headache were higher in women. In the remaining 21 studies, it was reported that the sex factor was not associated with the effect of Ramadan fasting in the frequency and other outcomes of these diseases. Conclusion Currently, small attention is paid to sex as a determinant factor in patients while fasting during Ramadan. There appeared to be differences in the frequency and incidence of diseases in men and women during Ramadan. Closer attention to sex differences regarding the frequency and the progression of the diseases during fasting may help to improve patient care, especially to benefit those patients willing to fast during Ramadan.
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Affiliation(s)
- Rachida Roky
- Department of Biology, Laboratory of Physiopathology, Molecular Genetics & Biotechnology, Faculty of Sciences Ain Chock, Health and Biotechnology Research Centre, Hassan II University of Casablanca, Casablanca, Morocco
| | - Nadia Aadil
- Department of Biology, Laboratory of Microbiology, Pharmacology, Toxicology, Biotechnology and Environment Faculty of Sciences Ain Chock, Hassan II University of Casablanca, Casablanca, Morocco
| | - Al Mehdi Krami
- Department of Biology, Laboratory of Physiopathology, Molecular Genetics & Biotechnology, Faculty of Sciences Ain Chock, Health and Biotechnology Research Centre, Hassan II University of Casablanca, Casablanca, Morocco
| | - Brahim Benaji
- Health Technologies Engineering Department, Research Group in Biomedical Engineering and Pharmaceutical Sciences, ENSAM, Mohammed V University, Agdal, Morocco
| | - Ikram Errabih
- Gastroenterology Department, Ibn Sina Hospital, Mohammed V University, Agdal, Morocco
| | - Dana N. Abdelrahim
- Department of Clinical Nutrition and Dietetics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - MoezAlIslam Ezzat Faris
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
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A Al-Samhari G, M Al-Mushiki G, Tamrakar R, Abdullahi G, Lin YD, Tang XY. Fasting, Nutrition and Weight Loss: An Approach to Refine Non-Alcoholic Fatty Liver Disease. J Nutr Sci Vitaminol (Tokyo) 2022; 67:366-374. [PMID: 34980714 DOI: 10.3177/jnsv.67.366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is considered as one of the most common causes of chronic liver disease. It includes a group of conditions associated with fat deposition in liver cells. Also, NAFLD is strongly associated with obesity and insulin resistance (IR). Until now, there is no pharmacological treatment validated for this disease. Fasting, nutritional intervention, and weight loss can be considered the first line in treating hepatic steatosis. This review is based on the scientific evidence showing the results of these interventions in the past years. The results include fasting and nutritional support for NAFLD treatment in humans. In clinical trials and cohort studies, an increase in hepatic fat content was correlated with a weight loss of at least 7% and a diet resembling the Mediterranean diet (MD) improving hepatic biomarkers and histological regression of NAFLD. Fasting is a dietary approach known to improve the lipid profile in healthy and obese populations by decreasing overall cholesterol, triglycerides, LDL, and increasing HDL. Bariatric surgery helps improve liver fat content in patients with serious health problems due to overweight.
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Affiliation(s)
| | | | - Rashi Tamrakar
- Internal Medicine, The First Affiliated Hospital of Guangxi Medical University
| | - Gibirima Abdullahi
- Internal Medicine, The First Affiliated Hospital of Guangxi Medical University
| | - Yue-Dong Lin
- School of Public Health, Guangxi Medical University
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8
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Tootee A, Larijani B. Ramadan fasting and diabetes, latest evidence and technological advancements: 2021 update. J Diabetes Metab Disord 2021; 20:1003-1009. [PMID: 33996651 PMCID: PMC8108432 DOI: 10.1007/s40200-021-00804-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Development of updated guidelines for management of diabetes in Ramadan Fasting is of paramount importance. Nonetheless, evidence-based guidelines in the field of Ramadan Fasting and Diabetes are scarce. Moreover, findings of some recent research such as effects of Ramadan fasting on microbiota, genetics and epigenetics, hormonal changes (such as adiponectin, leptin, testosterone…), and alternations in circadian rhythm should also be reviewed and included on a yearly basis. It is documented that self-monitoring of blood glucose (SMBG) is of vital importance for patients with type 1 diabetes who fast, and advantages of continuous glucose monitoring (CGM) or flash glucose monitoring (FGM) techniques should be highlighted. Moreover, the recent findings about applications of advanced insulin delivery technology in patients with diabetes who fast in Ramadan should also considered in the annual updates of the guidelines.
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Affiliation(s)
- Ali Tootee
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Institute, Beneath Dr. Shariati Hospital, 3rd floor, Gomnam highway, Tehran, 1411713137 Iran
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9
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Tootee A, Larijan B. Ramadan fasting and diabetes, latest evidence and technological advancements: 2021 update. J Diabetes Metab Disord 2021; 20:1085-1091. [PMID: 33968836 PMCID: PMC8088403 DOI: 10.1007/s40200-021-00806-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 02/07/2023]
Abstract
Development of updated guidelines for management of diabetes in Ramadan Fasting is of paramount importance. Nonetheless, evidence-based guidelines in the field of Ramadan Fasting and Diabetes are scarce. Moreover, findings of some recent research such as effects of Ramadan fasting on microbiota, genetics and epigenetics, hormonal changes (such as adiponectin, leptin, testosterone…), and alternations in circadian rhythm should also be reviewed and included on a yearly basis. It is documented that self-monitoring of blood glucose (SMBG) is of vital importance for patients with type 1 diabetes who fast, and advantages of continuous glucose monitoring (CGM) or flash glucose monitoring (FGM) techniques should be highlighted. Moreover, the recent findings about applications of advanced insulin delivery technology in patients with diabetes who fast in Ramadan should also considered in the annual updates of the guidelines.
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Affiliation(s)
- Ali Tootee
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijan
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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10
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Dietary Management of Type 2 Diabetes in the MENA Region: A Review of the Evidence. Nutrients 2021; 13:nu13041060. [PMID: 33805161 PMCID: PMC8064070 DOI: 10.3390/nu13041060] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/21/2021] [Accepted: 03/21/2021] [Indexed: 12/11/2022] Open
Abstract
The alarmingly rising trend of type 2 diabetes constitutes a major global public health challenge particularly in the Middle Eastern and North African (MENA) region where the prevalence is among the highest in the world with a projection to increase by 96% by 2045. The economic boom in the MENA region over the past decades has brought exceptionally rapid shifts in eating habits characterized by divergence from the traditional Mediterranean diet towards a more westernized unhealthy dietary pattern, thought to be leading to the dramatic rises in obesity and non-communicable diseases. Research efforts have brought a greater understanding of the different pathways through which diet and obesity may affect diabetes clinical outcomes, emphasizing the crucial role of dietary interventions and weight loss in the prevention and management of diabetes. The purpose of this review is to explore the mechanistic pathways linking obesity with diabetes and to summarize the most recent evidence on the association of the intake of different macronutrients and food groups with the risk of type 2 diabetes. We also summarize the most recent evidence on the effectiveness of different macronutrient manipulations in the prevention and management of diabetes while highlighting the possible underlying mechanisms of action and latest evidence-based recommendations. We finally discuss the need to adequately integrate dietetic services in diabetes care specific to the MENA region and conclude with recommendations to improve dietetic care for diabetes in the region.
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11
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Zabeen B, Nahar J, Ahmed B, Islam N, Azad K, Donaghue K. High HbA1c is not a reason not to fast during Ramadan in Children, adolescents and young adults with Type 1 diabetes - An observational study in Bangladesh. Diabetes Res Clin Pract 2021; 173:108673. [PMID: 33539866 DOI: 10.1016/j.diabres.2021.108673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/12/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
AIMS Our aim was to investigate the ability, frequency of acute complications and impact on glycemic control in uncontrolled T1DM who fasted during Ramadan. METHODS 74 Patients with T1D who insisted on fasting were enrolled 1 month prior to Ramadan and given intensive education by Diabetes team on insulin dose, glucose monitoring and dietary adjustments. Patients were divided into two groups ; group A- HbA1c < 9%(<75 mmol/mol) and group B- HbA1c ≥ 9% (≥75 mmol/mol) and different variables were compared. RESULTS Most of the patients fasted 58 (78.4%) for more than 15 days. There was no significant difference (p = 0.790), while comparing the breaking the fast in the two groups. Hypoglycaemia was common acute complications among them. There was no significant difference in the frequency of hypoglycaemia between two groups (P = 0.448). There was increased insulin requirement in both groups during Ramadan (p = 0.00001), with an increase in basal insulin in well controlled (from 24 to 34 units). There was significant reduction of Post Ramadan mean HbA1C in both groups [P = 0.0001)]. CONCLUSION Children, adolescents and young adults with T1D with poor glycaemic control can fast safely during Ramadan with proper education and intensive monitoring.
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Affiliation(s)
- Bedowra Zabeen
- Department of Paediatrics, BIRDEM2, Diabetic Association of Bangladesh.
| | - Jebun Nahar
- Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders 2, Dhaka 1000, Bangladesh
| | - Bulbul Ahmed
- Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders 2, Dhaka 1000, Bangladesh
| | - Nasreen Islam
- Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders 2, Dhaka 1000, Bangladesh
| | - Kishwar Azad
- Department of Paediatrics, BIRDEM2, Diabetic Association of Bangladesh
| | - Kim Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead Sydney, Australia
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12
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Mohd Yusof BN, Yahya NF, Hasbullah FY, Wan Zukiman WZHH, Azlan A, Yi RLX, Marczewska A, Hamdy O. Ramadan-focused nutrition therapy for people with diabetes: A narrative review. Diabetes Res Clin Pract 2021; 172:108530. [PMID: 33157118 DOI: 10.1016/j.diabres.2020.108530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/26/2020] [Indexed: 11/19/2022]
Abstract
AIMS This narrative review aimed to synthesize the evidence on the effects of Ramadan-focused nutrition therapy for people with diabetes. METHODS We searched MEDLINE (via PubMed) and Science Direct databases for articles that included the component of nutrition for adult patients with type 2 diabetes (T2D), published in English between 2010 and 2020. RESULTS Fourteen studies met the criteria. Eight of 14 studies had an intervention with a control arm. In comparison to the control group, all studies (n = 8) showed a reduction in hypoglycemic events. However, only half of these studies (n = 4) had shown at least one positive clinical outcome. Features of nutrition therapy that appeared to have favorable clinical outcomes include individualized caloric prescription; distributing carbohydrates equally between Suhoor, Iftar and snacks; providing meal plans; adjusting food intake to suit Ramadan; and incorporating diabetes-specific formula as part of Suhoor or snack. CONCLUSIONS The review provides evidence for the effectiveness of Ramadan-focused nutrition therapy among people with T2D and identifies key features of nutrition therapy that may provide favourable clinical outcomes. Additional data on dietary quality and adequacy during Ramadan fasting warrants further studies.
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Affiliation(s)
- Barakatun-Nisak Mohd Yusof
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia; Research Centre of Excellent for Nutrition and Noncommunicable Chronic Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia; Institute for Social Science Studies, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
| | - Nor Farahain Yahya
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Farah Yasmin Hasbullah
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | | | - Azrina Azlan
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia; Research Centre of Excellent for Nutrition and Noncommunicable Chronic Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | | | | | - Osama Hamdy
- Joslin Diabetes Centre, Harvard Medical School, MA 02215, USA
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13
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Abdelrahim D, Faris ME, Hassanein M, Shakir AZ, Yusuf AM, Almeneessier AS, BaHammam AS. Impact of Ramadan Diurnal Intermittent Fasting on Hypoglycemic Events in Patients With Type 2 Diabetes: A Systematic Review of Randomized Controlled Trials and Observational Studies. Front Endocrinol (Lausanne) 2021; 12:624423. [PMID: 33763029 PMCID: PMC7984365 DOI: 10.3389/fendo.2021.624423] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/11/2021] [Indexed: 01/14/2023] Open
Abstract
Ramadan is the 9th month of the lunar calendar during which Muslims abstain from food and drink between dawn and sunset for 30 consecutive days. Ramadan fasting is observed by all healthy Muslim adults, as well many Muslims with type 2 diabetes (T2DM). Hypoglycemic events (HE) are a serious complication associated with diabetes management and are associated with increased cardiovascular disease risk. Conflicting results have been reported concerning the incidence of HE among people with T2DM observing Ramadan fasting. This review summarizes available scientific evidence on the occurrence of HE and the effects of different moderators on the incidence of HE among patients with T2DM during Ramadan. We conducted a systematic review of available observational studies and randomized controlled trials (RCTs) for patients with T2DM who fasted during Ramadan, with HE as the primary outcome. Ten databases were searched for relevant studies from inception until October 31, 2020. In total, 68 studies (35 RCTs and 33 observational studies) met the inclusion criteria. Non-sulfonylureas hypoglycemic medications showed superior effects in lowering the incidence of HE over sulfonylureas hypoglycemic medications. Variable moderators were associated with experiencing HE during Ramadan in both observational studies and RCTs, including sex, geographical location, body anthropometric indicators, season, dietary behaviors, fasting duration, time since diagnosis, and pre-fasting education. This comprehensive systematic review covered the largest number of observational and clinical studies investigating the impact of Ramadan on HE among patients with T2DM. The study highlights the significance of different moderators that influence the effect of Ramadan fasting on HE, including dietary behaviors, fasting time duration, sex, season, country, pre-fasting education, age, and time since diagnosis. The study also highlighted the impact of different hypoglycemic medications on HE and noted the superiority of non-sulfonylureas over sulfonylureas hypoglycemic medications in lowering the risk for hypoglycemia in people with T2DM during Ramadan fasting.
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Affiliation(s)
- Dana Abdelrahim
- Department of Nutrition and Food Technology, Faculty of Agriculture, The University of Jordan, Amman, Jordan
| | - MoezAlIslam E. Faris
- Department of Clinical Nutrition and Dietetics, College of Health Sciences/Research Institute for Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
- *Correspondence: Ahmed S. BaHammam, ; MoezAlIslam E. Faris, ;
| | - Mohamed Hassanein
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Ayman Z. Shakir
- Department of Clinical Nutrition and Dietetics, College of Health Sciences/Research Institute for Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Ayesha M. Yusuf
- Department of Clinical Nutrition and Dietetics, College of Health Sciences/Research Institute for Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | | | - Ahmed S. BaHammam
- Department of Medicine, College of Medicine, The University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia
- *Correspondence: Ahmed S. BaHammam, ; MoezAlIslam E. Faris, ;
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Hsu YT, Chen HJ, Yufika A, Zufry H. Dietary knowledge, preferences and behaviors in Ramadan among Muslim patients with type 2 diabetes. Diabetes Res Clin Pract 2020; 170:108474. [PMID: 33002554 DOI: 10.1016/j.diabres.2020.108474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/04/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
AIMS To explore the association between dietary knowledge, attitude, and practices during Ramadan among Muslim patients with type 2 diabetes. METHODS Recruited after Ramadan from public clinics and a hospital in Banda Aceh, Indonesia, 401 outpatients recalled their food consumption frequencies of high-fiber food, deep-fried food, and high-sugar dessert, and relevant knowledge and attitudes. Multivariable logistic regression models were applied to examine the research questions. RESULTS Vegetable consumption and preference were both high among the patients. However, only 4.5% knew that brown rice is rich in fiber, and 19% agreed that whole-grain foods were accessible. Deep-fried food consumption and its availability at home was common, even though the majority considered it should be avoided. Patients with a lower preference for deep-fried foods were less likely to consume deep-fried foods during Ramadan (OR = 0.239, 95% CI = 0.109-0.523, p = 0.001). Knowledge of the glycemic index's health implication was associated with more high-fiber foods consumption (OR = 2.733, 95% CI = 1.179-6.332, p = 0.019). Yet, knowing the potential risk of added sugar on blood glucose level was associated with high-sugar dessert consumption (OR = 2.997, 95% CI = 1.482-6.060, p = 0.002). CONCLUSION The patients' low consumption of whole-grain food and common comsumption of deep-fried food during Ramadan would be the first priority to be improved. Along with dietary knowledge and attitude, food environment could be an important factor that influences patients' dietary behaviors.
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Affiliation(s)
- Yi-Tien Hsu
- International Health Program, Institute of Public Health, National Yang-Ming University, Taiwan
| | - Hsin-Jen Chen
- International Health Program, Institute of Public Health, National Yang-Ming University, Taiwan; Institute of Public Health, National Yang-Ming University, Taiwan.
| | - Amanda Yufika
- Department of Family Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Hendra Zufry
- Division of Endocrinology, Metabolism & Diabetes, School of Medicine Universitas Syiah Kuala, Banda Aceh, Indonesia; Dr. Zainoel Abidin General Teaching Hospital, Banda Aceh, Indonesia
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Al-Hariri M, Khan S, Albaker W, Al Malik W. Impact of Knowledge and Practice on Fasting Blood Glucose Levels among Diabetics During Ramadan Fasting. J Epidemiol Glob Health 2020; 9:288-293. [PMID: 31854171 PMCID: PMC7310796 DOI: 10.2991/jegh.k.190824.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 08/19/2019] [Indexed: 11/24/2022] Open
Abstract
The aim of the present study was to investigate the impact of knowledge and practice on the fasting blood glucose of diabetic patients during the month of Ramadan. The simple random sampling technique was used to calculate sample size and the computed sample size was 112. Participants were recruited from the diabetic outpatient clinics at King Fahad Hospital of the University, Dammam, Saudi Arabia. The participants included male and female adults with either type 1 or 2 diabetes, aged 15–70 years. Children, pregnant women, and those who were unable to complete at least 3 weeks of fasting during the study period were excluded from the study. Fasting blood glucose reading of the participants was extracted during Ramadan and in Shawwal (after 30 days) and a first-visit questionnaire related to the knowledge and practice was provided to them. Statistical Package for Social Sciences (version 22) was used for data entry and analysis. A two way ANOVA test, two independent sample t-tests and Chi-square test were used to compare between the groups. A p-value at 0.05 was considered statistically significant. The study found that fasting blood glucose of a participant during the holy month of Ramadan (144.2) was statistically significant with p-value 0.0003 as compared with after Ramadan (178.5). Moreover, it was found that as the level of knowledge (poor, average, good) improved, the fasting blood glucose goes down with p-values 0.036 and 0.037. Our results revealed that fasting during Ramadan significantly decreases blood glucose. The overall level of knowledge and practice concerning diabetes among the participants studied during the month Ramadan is average.
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Affiliation(s)
- Mohammed Al-Hariri
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Soban Khan
- Department of Clinical Affairs, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Walid Albaker
- Department of Internal medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Waleed Al Malik
- Department of Gynecology and Obstetrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Iqbal MD, Askari S, Ahmedani MY. The frequency of major complications among fasting people with diabetes according to risk categories of IDF-DAR guidelines 2016. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Effects of Time-Restricted Feeding during Ramadan on Dietary Intake, Body Composition and Metabolic Outcomes. Nutrients 2020; 12:nu12082478. [PMID: 32824528 PMCID: PMC7468808 DOI: 10.3390/nu12082478] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/14/2020] [Indexed: 12/24/2022] Open
Abstract
Ramadan fasting is a form of time-restricted feeding which combines a fast and feast period daily for a duration of one month every year. During Ramadan, Muslims abstain from food and drink consumption from dawn till sunset and this change in the meal schedule and frequency results in significant changes to the composition of the diet, such as energy and nutrient intake. These changes in dietary habits and their corresponding effects on cardiometabolic disease risk are compiled in this review. Ramadan fasting shows limited benefits to body composition via reductions in body mass in both healthy and obese individuals, although the results are often found to be transient and heterogeneous. There is, however, a more consistent improvement in blood lipid profile during Ramadan fasting, which often lasts beyond the Ramadan period. The results for glucose homeostasis, on the contrary, are more conflicting and inconclusive. The heterogeneity in the findings from the various studies can be generally attributed to cultural variations in dietary habits, differences in the duration of fasting due to seasonal/climatic differences at various geographical locations, age, gender and socioeconomic status, as well as other health and lifestyle factors of the various study populations.
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Aydin N, Kul S, Karadağ G, Tabur S, Araz M. Effect of Ramadan fasting on glycaemic parameters & body mass index in type II diabetic patients: A meta-analysis. Indian J Med Res 2020; 150:546-556. [PMID: 32048618 PMCID: PMC7038805 DOI: 10.4103/ijmr.ijmr_1380_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background & objectives: There has been an ongoing debate about the impact of Ramadan fasting (RF) on the health of these individuals who fast during Ramadan. The aim of this meta-analysis was to evaluate the relationship between RF and glycaemic parameters in type 2 diabetes mellitus (T2DM) patients. Methods: Search terms were decided and databases such as MEDLINE EBSCO, Google Scholar and EMBASE were searched for eligible studies. Standardized mean differences and 95 per cent confidence intervals (CIs) of post-prandial plasma glucose (PPG), fasting plasma glucose (FPG), glycated haemoglobin (HbA1c) (%) and fructosamine levels were calculated for different treatment regimens. Results: Of the 40 studies, 19 were found eligible for inclusion in the meta-analysis. Based on pooled results, significant reductions in FPG were found in single oral antidiabetics (OAD) [standardized weighted mean difference (SMD)=0.47, 95% CI=(0.20-0.74)], multi-OAD [SMD=0.36, 95% CI=(0.11-0.61)] and multitreatment subgroups [SMD=0.65, 95% CI=(0.03-1.27)] and overall [SMD=0.48, 95% CI=(0.27-0.70)]. Furthermore, HbA1c (%) [SMD=0.26, 95% CI=(0.03-0.49)] and body mass index (BMI) [SMD=0.18, 95% CI=(0.04-0.31)] were significantly decreased in the multi-OAD group. Interpretation & conclusions: The meta-analysis showed that RF was not associated with any significant negative effects on PPG and fructosamine levels. However, BMI and FPG and HbA1c (%) were positively affected by RF.
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Affiliation(s)
- Neriman Aydin
- Department of Public Health, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Seval Kul
- Department of Biostatistics, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Gülendam Karadağ
- Department of Public Health-Nursing School, Dokuz Eylül University, İzmir, Turkey
| | - Suzan Tabur
- Department of Internal Medicine, Division of Endocrinology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Mustafa Araz
- Department of Internal Medicine, Division of Endocrinology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
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Sahay R, Hafidh K, Djaballah K, Coudert M, Azar S, Shehadeh N, Hanif W, Hassanein M. Safety of lixisenatide plus basal insulin treatment regimen in Indian people with type 2 diabetes mellitus during Ramadan fast: A post hoc analysis of the LixiRam randomized trial. Diabetes Res Clin Pract 2020; 163:108148. [PMID: 32302665 DOI: 10.1016/j.diabres.2020.108148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/04/2020] [Indexed: 01/15/2023]
Abstract
AIMS Hypoglycemia is one of the most important complications associated with Ramadan fasting in people with type 2 diabetes. LixiRam (NCT02941367) was the first randomized trial comparing safety and efficacy of lixisenatide + basal insulin (BI) vs. sulphonylurea + BI in people with type 2 diabetes who fast during Ramadan. This post hoc analysis focuses on the LixiRam study population from India. METHODS Adults with type 2 diabetes insufficiently controlled with sulphonylurea + BI ± another oral anti-hyperglycemic drug were randomized 1:1 to receive lixisenatide + BI or to continue sulphonylurea + BI treatment. RESULTS In total, 150 participants were randomized in India. One participant (1.3%) with lixisenatide + BI vs. 5 participants (6.8%) with sulphonylurea + BI experienced ≥1 documented symptomatic hypoglycemic event during the Ramadan fast (odds ratio [OR]: 0.22; 95% confidence interval [CI]: 0.02-1.93). Incidence of any hypoglycemia was numerically lower with lixisenatide + BI vs. sulphonylurea + BI during Ramadan fasting (1.3% [1/75] vs. 14.7% [11/75], respectively; OR: 0.09; 95% CI: 0.01-0.69). No new safety signals were identified. CONCLUSIONS A combination of lixisenatide prandial GLP1-RA + BI may be a suitable treatment option for people with type 2 diabetes who elect to fast during Ramadan. Clinical Trial Registry: clinicaltrials.gov (NCT02941367).
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Affiliation(s)
- Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India.
| | | | | | | | - Sami Azar
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Wasim Hanif
- University Hospital Birmingham, Birmingham, UK
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Ulhaque MS, Bin Zafar A, Ahmed F, Ahmedani MY. Role of 24-hour Helpline Service in the Management of Diabetes During the Holy Month of Ramadan. Cureus 2020; 12:e7320. [PMID: 32313761 PMCID: PMC7164709 DOI: 10.7759/cureus.7320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective To assess the role of the 24-hour helpline service in the management of diabetes during the holy month of Ramadan. Methodology This prospective study was conducted at the Baqai Institute of Diabetology & Endocrinology, Baqai Medical University, Karachi, Pakistan, between December 2017 and August 2018. Patients with type 1 and type 2 diabetes who were willing to observe the fast in Ramadan 2018 were included. Pre-Ramadan education on a one-to-one basis was given and the 24-hour helpline number was provided to each patient. Details of baseline characteristics, anthropometric measurements, and biochemical parameters (lipid profile, serum creatinine, urine D/R (protein), and glycated hemoglobin A1c pre- and post-Ramadan) were noted. Self-monitoring blood glucose (SMBG) recording books were provided to each patient to record blood sugar levels during Ramadan. Results A total of 102 patients, 41 (40.2%) with type 1 diabetes and 61 (59.8%) with type 2 diabetes were included. The mean age of patients with type 1 diabetes was 17.02±5.22 years and that of patients with type 2 diabetes was 49.48±9.68 years. Most of the patients were male in both groups. By using the 24-hour helpline service, 912 calls were made to patients, 502 calls for type 1, and 410 calls for type 2 diabetes. Mean HbA1c (%) level before and after Ramadan was 8.94±1.72 and 8.70±2.03 in patients with type 1 diabetes and 8.59±1.73 and 7.71±1.27 in patients with type 2 diabetes, respectively. In the last 10 days of Ramadan, the decreasing trends of mean self-monitoring of blood glucose (SMBG) in patients with type 1 diabetes was observed for pre-dawn meal (suhoor), pre-sunset meal (iftar), and before sleeping while this trend in type 2 diabetes was found in the pre-dawn meal (suhoor)and two hours after iftar. Conclusion Pre-Ramadan diabetes education and treatment adjustment by using a station-based, 24-hour helpline service during the holy month of Ramadan have a significant role in controlling blood sugar levels, thus minimizing the complications of diabetes, facilitating timely adjustments in treatment, and reducing unnecessary hospital visits and admissions.
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Affiliation(s)
- Muhammad Saif Ulhaque
- Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, PAK
| | - Awn Bin Zafar
- Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, PAK
| | - Farrukh Ahmed
- Diet and Education, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, PAK
| | - Muhammad Yakoob Ahmedani
- Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, PAK
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Deeb A, Elbarbary N, Smart CE, Beshyah SA, Habeb A, Kalra S, Al Alwan I, Babiker A, Al Amoudi R, Pulungan AB, Humayun K, Issa U, Jalaludin MY, Sanhay R, Akanov Z, Krogvold L, de Beaufort C. ISPAD Clinical Practice Consensus Guidelines: Fasting during Ramadan by young people with diabetes. Pediatr Diabetes 2020; 21:5-17. [PMID: 31659852 DOI: 10.1111/pedi.12920] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Asma Deeb
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi & Gulf University, Ajman, UAE
| | - Nancy Elbarbary
- Diabetes Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Carmel E Smart
- Pediatric Endocrinology, John Hunter Children's Hospital & School of Health Sciences, University of Newcastle, Newcastle, Australia
| | | | - Abdelhadi Habeb
- Pediatric Department, Prince Mohammed Bin Abdulaziz Hospital for National Guard, Madinah, KSA
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - Ibrahim Al Alwan
- Department of Pediatrics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Amir Babiker
- King Saud Bin Abdulaziz, University for Health Sciences, Riyadh, Saudi Arabia
| | - Reem Al Amoudi
- Department of Medicine, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Research Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Aman Bhakti Pulungan
- Endocrinology Division, Child Health Department, Faculty of Medicine University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Khadija Humayun
- Department of Pediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Umer Issa
- Department of Paediatrics, Bayero University & Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Rakesh Sanhay
- Department of Endocrinology, Osmania Medical College, Hyderabad, Telangana, India
| | - Zhanay Akanov
- Kazakh Society for Study of Diabetes, Almaty, Republic of Kazakhstan
| | - Lars Krogvold
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Carine de Beaufort
- Department of Pediatric Diabetes and Endocrinology, Centre Hospitalier Luxembourg, Luxembourg.,Department of Pediatrics, Free University Brussels (VUB), Brussels, Belgium
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Yasmin F, Ali L, Banu B, Rasul FB, Sauerborn R, Souares A. Understanding patients' experience living with diabetes type 2 and effective disease management: a qualitative study following a mobile health intervention in Bangladesh. BMC Health Serv Res 2020; 20:29. [PMID: 31918704 PMCID: PMC6953219 DOI: 10.1186/s12913-019-4811-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2017, 425 million adults worldwide had diabetes; 80% were living in low and middle-income countries. Bangladesh had 6.9 million adults with diabetes; death from diabetes comprised 3% of the country's total mortality. This study looked at different factors (personal, familial, social, and financial) affecting both the life of patients with diabetes type 2 and the management of the disease. It also explored patient's perception of the mobile health intervention in the context of disease management and helped to explain the findings obtained from the quantitative part of this study. METHOD The study was a mixed-method, sequential explanatory design. A mobile health project (interactive voice call and call center) was implemented in Dhaka district, Bangladesh from January to December, 2014. Patients received treatment at the outpatient department of Bangladesh Institute of Health Science Hospital, Dhaka, Bangladesh, were included in intervention and control groups of the main study following a Randomized Control Trial. Among them, a total of 18 patients (9 + 9) were selected purposefully for the qualitative study, which was conducted in July, 2015. The sample was selected purposefully considering the age, sex, socio-economic status and proximity of living due to the political instability of the country during the data collection period. The interviews were transcribed and analyzed applying investigator triangulation. RESULTS Most patients stated that diabetes has affected their lives. In general, both groups´ evaluation of mobile health services were good and both regarded the recommendations for medication, diet, physical exercise, and other lifestyle behaviors (use of tobacco and betel nuts) as helpful. The cost of overall treatment (medications, physician consultations, laboratory investigations), the lack of availability of safe public places for physical exercise and unfavorable weather conditions (heat, rainfall) were mentioned as barriers to the overall management of the disease. CONCLUSION A patient-centered mobile health intervention supported by a collaborative patient-provider relationship, a strong family support system, available public spaces for exercise and the introduction of a functional public health insurance system could be beneficial for the better management of diabetes.
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Affiliation(s)
- F Yasmin
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120, Heidelberg, Germany.
- Faculty of Health/Department of Human Medicine, University Witten/Herdecke, 58448, Witten, Germany.
| | - L Ali
- Bangladesh University of Health Sciences (BUHS), Mirpur-1, Dhaka, 1216, Bangladesh
| | - B Banu
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - F B Rasul
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120, Heidelberg, Germany
- BRAC James P. Grant School of Public Health, BRAC University, Mohakhali, Dhaka, 1212, Bangladesh
| | - R Sauerborn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - A Souares
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120, Heidelberg, Germany
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Abdessadek M, Khabbal Y, Magoul R, Marmouzi I, Ajdi F. Follow-up of glycemic index before and after Ramadan fasting in type 2 diabetes patients under antidiabetic medications. ANNALES PHARMACEUTIQUES FRANÇAISES 2019; 77:374-381. [DOI: 10.1016/j.pharma.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/28/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
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Beltaief K, Bouida W, Trabelsi I, Baccouche H, Sassi M, Dridi Z, Chakroun T, Hellara I, Boukef R, Hassine M, Addad F, Razgallah R, Khochtali I, Nouira S. Metabolic effects of Ramadan fasting in patients at high risk of cardiovascular diseases. Int J Gen Med 2019; 12:247-254. [PMID: 31410047 PMCID: PMC6643153 DOI: 10.2147/ijgm.s172341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 02/14/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND AIM The effects of Ramadan fasting on health are a little controversial. The present study is aimed at evaluating the metabolic effects on a group of 517 patients with ≥2 cardiovascular risk factors over a period running from 2012 to 2014. METHODS Each patient was assessed at three visits: before, during, and after Ramadan. Demographical, clinical and biological tests were performed at each visit. RESULTS Metabolically, we noted a significant and discrete rise in blood glucose level (+1.2 mmol/L), triglycerides (+0.3 mmol/L), cholesterol (+0.12 mmol/L) and creatinine (+3 µmol/L) during Ramadan. These disturbances decreased significantly after Ramadan. The same variations were observed among diabetics (n=323). However, there was a significant decrease in HbA1c after Ramadan (9.0% vs 7.6%, p<0.001). Our findings also revealed there was no significant correlation between variations of metabolic parameters and dietary intake. No acute metabolic incidents were reported during the study period. CONCLUSION The current study showed that Ramadan is responsible for a transient but well tolerated disturbance of metabolic parameters followed by a significant post-Ramadan improvement. These changes did not seem to be directly related to dietary intake.
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Affiliation(s)
- K Beltaief
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | - W Bouida
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | - I Trabelsi
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | - H Baccouche
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | - M Sassi
- Biological Laboratory, Maternity and Neonatal Medicine Center, Monastir, Tunisia
| | - Z Dridi
- Cardiology Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - T Chakroun
- Regional Blood Transfusion Center, Farhat Hached University Hospital, Sousse, Tunisia
| | - I Hellara
- Hematology Department, Fattouma Bourguiba University Hospital, Monasitr, Tunisia
| | - R Boukef
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - M Hassine
- Hematology Department, Fattouma Bourguiba University Hospital, Monasitr, Tunisia
| | - F Addad
- Cardiology Department, Abderrahman Mami University Hospital, Ariana1080, Tunisia
| | | | - I Khochtali
- Endocrinology and Internal Medicine Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - S Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
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Beshyah WS, Beshyah SA. Bibliometric analysis of the literature on Ramadan fasting and diabetes in the past three decades (1989-2018). Diabetes Res Clin Pract 2019; 151:313-322. [PMID: 30904744 DOI: 10.1016/j.diabres.2019.03.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/14/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To quantify the research contribution related to Ramadan fasting and diabetes. METHODS We searched for the combination of "Ramadan" and Diabetes" in the title, abstract and keywords in the Scopus database between 1989 and 2018. Articles were analysed for standard bibliometric methodology and VOSviewer was used to construct bibliometric diagrams. RESULTS The total number of retrieved articles was 424 articles; 112 were "Open Access". Two-thirds of articles covered original research. Articles were published in medical journals of varying influence. UK-based authors and affiliated institutions were dominant. A single author has an evident dedication to Ramadan research whereas for many authors it Ramadan research was just one aspect of their academic interest. The number publications and the extent of international collaborations were lower than expected, given the world-wide practice of Ramadan fasting by many populations with an increased prevalence of diabetes. The need to share experiences and generalizable conclusions. CONCLUSIONS This is the first bibliometric study on diabetes in Ramadan. It is a good starting point to evaluate gaps in research activity in the field and should help identify future research directions and foster more collaboration.
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Affiliation(s)
- Waleed S Beshyah
- Internal Medicine Residency Program, Institute of Education, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Division of Endocrinology, Institute of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Salem A Beshyah
- Division of Endocrinology, Institute of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates.
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Elbarbary N, Deeb A, Habeb A, Beshyah SA. Management of diabetes during Ramadan fasting in children and adolescents: A survey of physicians' perceptions and practices in the Arab Society for Paediatric Endocrinology and Diabetes (ASPED) countries. Diabetes Res Clin Pract 2019; 150:274-281. [PMID: 30629966 DOI: 10.1016/j.diabres.2018.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/25/2018] [Indexed: 11/28/2022]
Abstract
AIM To ascertain the pattern of diabetes management during Ramadan fasting in childhood and adolescence among physicians in Arab countries. METHODS An online electronic survey questionnaire was distributed to physicians registered in the Arab society for Paediatric Endocrinology and Diabetes (ASPED). RESULTS Of the 167 responders, 114 (86.0%) were paediatricians and the remaining 14.4% were adult physicians. 117 (79.6%) would allow patients to fast and 60.7% of them emphasized providing education before fasting. 69.1% of physicians thought that their patients complete >50% of fasting days. 46.9% recognized those with hypoglycemia unawareness among the very high-risk group for fasting. 62% reported that fasting should be broken if symptomatic hypoglycemia regardless of glucose level and 48.2% indicated that blood glucose above 300 mg/dl is another indication. 63.4% of respondents would decrease basal insulin by 25%, and 52.8% reported that using insulin pump during fasting reduced the frequency of hypoglycemia. 81.1% recommend several dietary adjustments and 56.4% used rapid-acting insulin analog according to carbohydrate counting. CONCLUSIONS There is a wide variation in the management of children and adolescents with diabetes during Ramadan in ASPED countries. A targeted educational program for physicians and establishing a guideline for this challenging area is needed.
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Affiliation(s)
| | - Asma Deeb
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Abdelhadi Habeb
- Prince Mohammed bin Abdulaziz Hospital for National Guard, Madinah, KSA
| | - Salem A Beshyah
- Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Dubai Medical College, Dubai, United Arab Emirates
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Malek R, Hannat S, Nechadi A, Mekideche FZ, Kaabeche M. Diabetes and Ramadan: A multicenter study in Algerian population. Diabetes Res Clin Pract 2019; 150:322-330. [PMID: 30779972 DOI: 10.1016/j.diabres.2019.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/02/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aims of this study are to describe the behaviour of an Algerian population with diabetes and the consequences of fasting. METHODS In 2017, a prospective multicenter study was conducted in 26 counties before and after fasting. The study concerned 901 patients with 836 type 2 diabetes mellitus (T2DM) and 65 with type 1 diabetes mellitus (T1DM). RESULTS The average age for T2DM and T1DM was 57.86 ± 10.44 and 45.8 ± 17.69 years respectively. The duration of diabetes was 9.09 ± 8.19 for T1DM and 7.87 ± 5.97 years for T2DM. 89.1% of T2DM and 69.2% of T1DM fasted during Ramadan. 51.4% of T2DM were classified among the high and very high risk. The average glycemia increased (162 ± 49 mg/dL vs. 197 ± 65 mg/dl) (p 0.035 × 10-6)]. About 30% of patients had hypoglycemic episodes. Self-monitoring blood glucose (SMBG) during Ramadan was not conform to the physicians' advice and thus significantly lowered than suggested (2.6 vs. 3.4 per day). The therapeutic adjustment was mainly a reduction in insulin dose and glucose-lowering agents. CONCLUSION Diabetic patients insist on fasting regardless of their doctors' warnings. The main consequences were hyperglycemia and hypoglycemia. SMBG was less checked during Ramadan. Therapeutic education remains unsufficient and needs much more emphasis.
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Affiliation(s)
- Rachid Malek
- Department of Internal Medicine, Setif University Hospital, Algeria.
| | - Souad Hannat
- Department of Internal Medicine, Setif University Hospital, Algeria
| | | | | | - Meriem Kaabeche
- Department of Internal Medicine, Setif University Hospital, Algeria
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Hassanein MM, Sahay R, Hafidh K, Djaballah K, Li H, Azar S, Shehadeh N, Hanif W. Safety of lixisenatide versus sulfonylurea added to basal insulin treatment in people with type 2 diabetes mellitus who elect to fast during Ramadan (LixiRam): An international, randomized, open-label trial. Diabetes Res Clin Pract 2019; 150:331-341. [PMID: 30772385 DOI: 10.1016/j.diabres.2019.01.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/31/2019] [Indexed: 12/21/2022]
Abstract
AIMS Adding lixisenatide to basal insulin (BI) instead of sulfonylurea (SU), versus continuing SU + BI was assessed in people with type 2 diabetes mellitus (T2DM) who intended to fast during Ramadan 2017. METHODS LixiRam (NCT02941367) was a phase 4, randomized, open-label, 12-22-week study in people with T2DM insufficiently controlled with SU + BI ± 1 oral anti-diabetic. Endpoints included the percentage of participants with ≥1 documented symptomatic hypoglycemia event (plasma glucose ≤70 mg/dL; primary endpoint) and any hypoglycemia during Ramadan fasting. RESULTS A numerically lower percentage of participants with lixisenatide + BI (3.3%, 3/91) versus SU + BI (8.9%, 8/90) had ≥1 documented symptomatic hypoglycemia event (intent-to-treat visit 4) during Ramadan fasting (OR: 0.34; 95% CI 0.09, 1.35; proportion difference -0.06, 95% CI -0.13, 0.01); the difference was statistically significant for the 'any hypoglycemia' category (lixisenatide + BI: 4.3%, 4/92; SU + BI: 17.4%, 16/92; OR: 0.22; 95% CI 0.07, 0.68; proportion difference -0.13, 95% CI -0.22, -0.04; intent-to-treat). No new treatment-emergent adverse events occurred. CONCLUSIONS Compared with SU + BI, lixisenatide + BI provided lower rates of any hypoglycemia in people with T2DM during Ramadan fasting. Lixisenatide + BI therapy may be a suitable treatment option during fasting.
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Affiliation(s)
| | | | | | | | - Haoyu Li
- Sanofi-Aventis (China), Chaoyang District, Beijing, China.
| | - Sami Azar
- American University of Beirut Medical Center, Beirut, Lebanon.
| | | | - Wasim Hanif
- University Hospital Birmingham & Institute of Translational Medicine, Edgbaston, Birmingham, UK.
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Bouida W, Beltaief K, Baccouche H, Sassi M, Dridi Z, Trabelsi I, Laaouiti K, Chakroun T, Hellara I, Boukef R, Sakly N, Hassine M, Added F, Razgallah R, Najjar F, Nouira S. Effects of Ramadan fasting on aspirin resistance in type 2 diabetic patients. PLoS One 2018. [PMID: 29529091 PMCID: PMC5846719 DOI: 10.1371/journal.pone.0192590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aims Ramadan fasting (RF) may affect aspirin resistance. We conducted this study in patients with cardiovascular risk (CVR) factors to assess the effect of RF on aspirin resistance and explore whether type 2 diabetes mellitus (DM) would influence this effect. Methods A total of 177 stable patients with ≥2 CVR factors were recruited. All patients observed RF and were taking aspirin. Physical exam and standard biological tests including glycaemia and serum lipids data were performed before Ramadan (Pre-R), at the last week of Ramadan (R) and four weeks after the end of Ramadan (Post-R). In the same visits caloric intake was calculated and platelet reactivity to aspirin was assessed using Verify Now point-of-care assay. Results In the overall population, there was no significant change in absolute aspirin reaction unit (ARU) values and in metabolic parameters. In DM patients (n = 127), ARU change from Pre-R values was+19.7 (p = 0.01) and +14.4 (p = 0.02) respectively at R and Post-R. During Ramadan, glycaemia, triglycerides, and cholesterol levels increased significantly and returned to Pre-R values thereafter. These changes were not observed in non-DM patients. Conclusions During RF aspirin resistance increased only in DM patients. This effect persisted one month after Ramadan. Simultaneous alteration of glycemic control and increase of serum lipids levels could potentially be a favorable factor. Study registration The protocol was registered at clinicaltrials.gov under: NCT02720133.
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Affiliation(s)
- Wahid Bouida
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
| | - Kaouthar Beltaief
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
| | - Houda Baccouche
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
| | - Mouna Sassi
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
- Biological Laboratory, Maternity and Neonatal Medicine Center, Monastir, Tunisia
| | - Zohra Dridi
- Cardiology Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
| | - Imen Trabelsi
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
| | - Kamel Laaouiti
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
| | - Taher Chakroun
- Regional blood transfusion center, FarhatHached University Hospital, Sousse, Tunisia
| | - Ilhem Hellara
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
- Hematology Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
| | - Riadh Boukef
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Nabil Sakly
- Laboratory of Immunology, FattoumaBourguiba University Hospital, Monastir Tunisia
| | - Mohsen Hassine
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
- Hematology Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
| | - Faouzi Added
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
- Cardiology Department, AbderrahmanMami University Hospital, Ariana Tunisia
| | | | - Fadhel Najjar
- Biochemistry Department, FattoumaBourguiba University Hospital, Monastir Tunisia
| | - Semir Nouira
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
- * E-mail:
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Savaş E. Attitudinal Determinants of Turkish Diabetic Patients and Physicians About Ramadan Fasting. JOURNAL OF RELIGION AND HEALTH 2018; 57:47-56. [PMID: 27830355 DOI: 10.1007/s10943-016-0327-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of the study was to investigate whether fasting diabetic patients received recommendations regarding fasting or they consulted the physicians before and during Ramadan along with the affect of sociodemographic factors on Ramadan fasting. The study was conducted on 190 diabetic patients after 2014 Ramadan Month. A questionnaire was collected regarding sociodemographic characteristics, diabetes-related characteristics, recommendations of physicians, and behavioral patterns of fasting patients. Overall 41.6% of diabetic patients fasted during Ramadan. 83.5% of them did not go to physician during Ramadan, 65.8% did not consult physicians before fasting and 12.7% were informed by physicians regarding fasting and diabetes. Result of the study was that both physicians and patients were not well aware of the importance of pre-Ramadan education and close follow-up during fasting.
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Affiliation(s)
- Esen Savaş
- Division of Social Medicine, Department of Internal Medicine, Faculty of Medicine, Gaziantep University, 27100, Gaziantep, Sahinbey, Turkey.
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Almalki MH, Hussen I, Khan SA, Almaghamsi A, Alshahrani F. Assessment of Ramadan Education and Knowledge Among Diabetic Patients. CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2018; 11:1179551417751611. [PMID: 29348712 PMCID: PMC5768264 DOI: 10.1177/1179551417751611] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/04/2017] [Indexed: 11/16/2022]
Abstract
Background: During Ramadan, Muslims fast from dawn until dusk for one lunar month every year. Most of the Muslim patients with diabetes are unaware of the potential complications that can occur while fasting, such as hypoglycemia. The aim of this study is to assess the the patient education level and patients’ overall awareness of any possible complications that could occur while fasting during Ramadan and to determine how these patients deal with these complications. Methods: We conducted a cross-sectional study and surveyed diabetic patients about their diabetes-related knowledge over a period of 4 months from the outpatient clinic at the Obesity, Endocrine, and Metabolism Center at King Fahad Medical City. Patients were included if they were ≥16 years and if they had been receiving treatment for at least 1 year before the study, irrespective of the medications used; patients were also asked about the presence or absence of complications. Results: This study included 477 patients (325 women and 152 men). Most patients (297; 62.3%) had type 2 diabetes. The patients’ mean age was 39.72 ± 15.29 years, and the mean duration of diabetes was 10.80 ± 5.88 years. During the preceding Ramadan, 76% of patients reported fasting, whereas 58% said that they monitored their blood glucose levels once per day. Hypoglycemic episodes were reported in 60.3% of cases with type 2 diabetes and in 8.3% of cases with type 1 diabetes. Among those who had hypoglycemia, 2.8% of patients with type 1 diabetes and 17.8% with type 2 diabetes broke their fast. Finally, 54% of patients reported that their health care providers offered them instructions on diabetes management during Ramadan. Conclusions: Ramadan health education in diabetes can encourage, improve, and guide patients to change their lifestyles during Ramadan while minimizing the risk of acute complications.
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Affiliation(s)
- Mussa Hussain Almalki
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City (KFMC), Riyadh, Saudi Arabia.,Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ibtihal Hussen
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City (KFMC), Riyadh, Saudi Arabia
| | - Shawana A Khan
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City (KFMC), Riyadh, Saudi Arabia
| | - Abdulrahman Almaghamsi
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City (KFMC), Riyadh, Saudi Arabia
| | - Fahad Alshahrani
- Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Family Medicine and Primary Health Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Al-Agha AE, Kafi SE, Zain Aldeen AM, Khadwardi RH. Flash glucose monitoring system may benefit children and adolescents with type 1 diabetes during fasting at Ramadan. Saudi Med J 2017; 38:366-371. [PMID: 28397942 PMCID: PMC5447188 DOI: 10.15537/smj.2017.4.18750] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To assess the benefit of using the flash glucose monitoring system (FGMS) in children and adolescents with type 1 diabetes mellitus (T1DM) during Ramadan fasting. Methods: A prospective pilot study of 51 participants visited the pediatric diabetes clinic at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia from between June until and July 2016. The FreeStyle® Libre™ FGMS (Abbott Diabetes Care, Alameda, CA, USA) was used. Hypoglycemia was defined as glucose values of less than 70 mg/dL, while hyperglycemia as glucose values of more than 150 mg/dL for all participants based on our institute’s protocol. Results: Participants were able to fast for 67.0% of the total days eligible for fasting, whereas they did not fast on 33% of the days due to either hypoglycemia (15.4%) or non-diabetes-related reasons (17.6 %). None of the participants developed severe hypoglycemia. The mean number of hyperglycemic episodes during fasting hours was 1.29, per day, which was higher than that of hypoglycemic episodes (0.7). None of the participants developed diabetic ketoacidosis (DKA). Glycemic control with mean of estimated hemoglobin A1C reading during Ramadan (8.16 ± 1.64% [pre study]) to 8.2 ± 1.63% [post study] p=0.932. Conclusions: Children and adolescents with T1DM who use the FGMS could fast without the risk of life-threatening episodes of severe hypoglycemia (namely seizure, coma), or DKA during Ramadan. Adequate education and good glycemic control prior to Ramadan are important strategies in combination with the use of an FGMS to achieve better outcome.
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Affiliation(s)
- Abdulmoein E Al-Agha
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Telemonitoring in fasting individuals with Type 2 Diabetes Mellitus during Ramadan: A prospective, randomised controlled study. Sci Rep 2017; 7:10119. [PMID: 28860546 PMCID: PMC5579057 DOI: 10.1038/s41598-017-10564-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/11/2017] [Indexed: 11/08/2022] Open
Abstract
We determined the impact of a remote blood glucose telemonitoring program with feedback in type 2 diabetes mellitus patients fasting during Ramadan compared to conventional self-monitoring method. A twelve-week cluster randomised study, with 85 participants who wish to fast for at least 15 days during Ramadan was conducted. Self-measurement and transmission of blood glucose results were performed six times daily during Ramadan. Results were transmitted to a secure website for review with feedback from case manager if necessary. The control group received usual care. The main outcome was the number of participants experiencing hypoglycaemia during Ramadan and at the end of the study. During Ramadan, the number of participants reporting hypoglycaemia was significantly lower in the telemonitoring group [Odds ratio (OR): 0.186, 95% confidence interval: 0.04-0.936; p = 0.04]. Similarly, the proportion of participants reporting symptomatic hypoglycaemia at the end of the study was significantly lower in the telemonitoring group (OR: 0.257, 95% CI: 0.07-0.89; p = 0.03). A reduction of 1.07% in glycated haemoglobin levels was observed in the telemonitoring group compared to 0.24% in the control group (p < 0.01). Overall, telemonitoring was a useful adjunct to reduce the risk of hypoglycaemia during Ramadan with no deterioration in glycaemic control.
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Bouida W, Baccouche H, Sassi M, Dridi Z, Chakroun T, Hellara I, Boukef R, Hassine M, Added F, Razgallah R, Khochtali I, Nouira S. Effects of Ramadan fasting on platelet reactivity in diabetic patients treated with clopidogrel. Thromb J 2017; 15:15. [PMID: 28588426 PMCID: PMC5457725 DOI: 10.1186/s12959-017-0138-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/25/2017] [Indexed: 12/12/2022] Open
Abstract
Background The effects of Ramadan fasting (RF) on clopidogrel antiplatelet inhibition were not previously investigated. The present study evaluated the influence of RF on platelet reactivity in patients with high cardiovascular risk (CVR) in particular those with type 2 diabetes mellitus (DM). Methods A total of 98 stable patients with ≥2 CVR factors were recruited. All patients observed RF and were taking clopidogrel at a maintenance dose of 75 mg. Clinical findings and serum lipids data were recorded before Ramadan (Pre-R), at the last week of Ramadan (R) and 4 weeks after the end of Ramadan (Post-R). During each patient visit, nutrients intakes were calculated and platelet reactivity assessment using Verify Now P2Y12 assay was performed. Results In DM patients, the absolute PRU changes from baseline were +27 (p = 0.01) and +16 (p = 0.02) respectively at R and Post-R. In addition, there was a significant increase of glycemia and triglycerides levels with a significant decrease of high-density lipoprotein. In non DM patients there was no significant change in absolute PRU values and metabolic parameters. Clopidogrel resistance rate using 2 cut-off PRU values (235 and 208) did not change significantly in DM and non DM patients. Conclusions RF significantly decreased platelet sensitivity to clopidogrel in DM patients during and after Ramadan. This effect is possibly related to an increase of glycemia and serum lipids levels induced by fasting. Trial registration Clinical Trials.gov NCT02720133. Registered 24 July 2014.Retrospectively registered.
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Affiliation(s)
- W Bouida
- Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000 Monastir, Tunisia
| | - H Baccouche
- Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000 Monastir, Tunisia
| | - M Sassi
- Laboratory of Biology, Maternity and Neonatal Medicine Center, 5000 Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000 Monastir, Tunisia
| | - Z Dridi
- Cardiology Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia
| | - T Chakroun
- Regional Blood Transfusion Center, Farhat Hached University Hospital, 4004 Sousse, Tunisia
| | - I Hellara
- Hematology Department, Fattouma Bourguiba University Hospital, 5000 Monasitr, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000 Monastir, Tunisia
| | - R Boukef
- Emergency Department, Sahloul University Hospital, 4011 Sousse, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000 Monastir, Tunisia
| | - M Hassine
- Hematology Department, Fattouma Bourguiba University Hospital, 5000 Monasitr, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000 Monastir, Tunisia
| | - F Added
- Cardiology Department, Abderrahman Mami University Hospital, 1080 Ariana, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000 Monastir, Tunisia
| | | | - I Khochtali
- Endocrinology and Internal Medicine Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000 Monastir, Tunisia
| | - S Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000 Monastir, Tunisia
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Ahmedani MY, Ahsan S, Haque MSU. Role of Ramadan specific diabetes education (RSDE); A prospective study. Pak J Med Sci 2017; 33:586-593. [PMID: 28811776 PMCID: PMC5510108 DOI: 10.12669/pjms.333.12345] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To observe the role of Ramadan Specific Diabetes Education (RSDE) in the management of fasting patients with diabetes. METHODS This prospective study was carried out at out-patients department (OPD) of Baqai Institute of Diabetology & Endocrinology (BIDE), in 2012. Recruitment of patients started a month prior to Ramadan. Muslim patients with diabetes whether had their first or on follow up visit to the OPD and showed intention to hold fast in the month of Ramadan, were included. A printed broacher focused on six cardinal areas of fasting and diabetes identified in Ramadan specific guidelines was given to all participants. All patients had their first visit to the OPD (n=32) were also given RSDE on one-to-one basis (Group A). Whereas patients had follow up visit were advised to attend a group session on RSDE. Those attended (n= 25) and those did not opt (n=45) the group session were included in Group B and Group C respectively. All participants were instructed to visit the OPD after Ramadan. Group D was constituted after Ramadan. It included patients who had not visited the OPD during induction period thus did not receive RSDE (n=76) they however hold fast in the month of Ramadan. Data regarding compliance to structured education through different modes was collected during post Ramadan visit. RESULTS Comparisons among groups who received education(A with B with C) revealed non-significant difference in self-monitoring of blood glucose, alteration of drug dosage and timing, appreciation of hypoglycemia and action taken on development of hypoglycemic symptoms. However, significant differences were noted when group who received education was compared individually with group who did not receive education. CONCLUSION Patients who receive Pre-Ramadan diabetes education were found to be significantly better in following Ramadan specific diabetes management recommendations compared to patients who did not receive education. Further large scale studies are needed to validate our findings.
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Affiliation(s)
- Muhammad Yakoob Ahmedani
- Muhammad Yakoob Ahmedani, FCPS. Professor of Medicine, Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Plot No. 1-2, II-B, Nazimabad No.2, Karachi, Pakistan
| | - Shahid Ahsan
- Shahid Ahsan, MBBS, M.Phil (Biochemistry), M.Phil (Public Health). Associate Professor, Department of Biochemistry, Hamdard College of Medicine and Dentistry, Hamdard University, Karachi, Pakistan
| | - Muhammad Saif Ul Haque
- Muhammad Saif ul Haque, MS (Diab & Endo), Registrar, Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Plot No. 1-2, II-B, Nazimabad No.2, Karachi, Pakistan
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Ahmed F, Asim-Bin-Zafar, Riaz M, Ghafoor E, Rehman RA, Uddin Q. Impact of 24-hour helpline service for people with diabetes. Pak J Med Sci 2017; 33:747-751. [PMID: 28811807 PMCID: PMC5510139 DOI: 10.12669/pjms.333.12689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To evaluate the impact and effectiveness of 24-hour helpline service in providing information and educating patients about self-management of diabetes. Method: The study was conducted at Baqai Institute of Diabetology & Endocrinology (BIDE), a tertiary diabetes care center, Karachi, Pakistan. People with diabetes attending the outpatient department from November 2012 to October 2014 were included in this study. After providing diabetes education, a helpline number was provided for emergency situations. Calls of registered patients were received by diabetes educators stationed at the BIDE around the clock. Data was collected through specially designed interface of HMS (health management system) in which the current complaint of caller and the advice of educator was recorded. Result: A total of 4842 calls were received. Out of those, 4268 (88%) were made by Type-2 diabetics and 526 calls (10%) were made by Type-1 diabetics. The average age of patients was 47.6 years. Three seventy-four calls (7.7%) were received with complaint of Hypoglycemia (72-80mg/dl). Six hundred and ninety-eight calls (14.4%) were received with complaint of hyperglycemia (>200mg/dl). Insulin dose was adjusted on 935 calls (19.3%). Calls regarding other special situations such as (insulin handling, technique, medicine information) 2014 (41.6%) were received. Conclusion: Station based 24-hour telephonic helpline service is an effective tool for providing continuous support to people with diabetes and their families, for the self-management of diabetes. It can help in the management of various acute complication of diabetes, thereby preventing unnecessary hospital visits and admission.
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Affiliation(s)
- Farrukh Ahmed
- Farrukh Ahmed, Diabetes Educator, Diet and Education Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Asim-Bin-Zafar
- Asim-Bin-Zafar, MD, Assistant Professor, Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Musarrat Riaz
- Musarrat Riaz, FCPS (Medicine and Endocrine), Assistant Professor, Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Erum Ghafoor
- Erum Ghafoor, Diabetes Educator, IDF-Expert Trainer for Diabetes Conversations Map tools Programme, Faculty member of young leaders in Diabetes (IDF), Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Rabia Abdul Rehman
- Rabia Abdul Rehman, Diabetes Educator, Diet and Education Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Qutub Uddin
- Qutub Uddin, Diabetes Educator, Diet and Education Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
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Goh SY, Hussein Z, Rudijanto A. Review of insulin-associated hypoglycemia and its impact on the management of diabetes in Southeast Asian countries. J Diabetes Investig 2017; 8:635-645. [PMID: 28236664 PMCID: PMC5584309 DOI: 10.1111/jdi.12647] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 01/13/2017] [Accepted: 02/21/2017] [Indexed: 02/06/2023] Open
Abstract
Although the incidence of diabetes is rising in Southeast Asia, there is limited information regarding the incidence and manifestation of insulin-associated hypoglycemia. The aim of the present review was to discuss what is currently known regarding insulin-associated hypoglycemia in Southeast Asia, including its known incidence and impact in the region, and how the Southeast Asian population with diabetes differs from other populations. We found a paucity of data regarding the incidence of hypoglycemia in Southeast Asia, which has contributed to the adoption of Western guidelines. This might not be appropriate, as Southeast Asians have a range of etiological, educational and cultural differences from Western populations with diabetes that might place them at greater risk of hypoglycemia if not managed optimally. For example, Southeast Asians with type 2 diabetes tend to be younger, with lower body mass indexes than their Western counterparts, and the management of type 2 diabetes with premixed insulin preparations is more common in Southeast Asia. Both of these factors might result in higher rates of hypoglycemia. In addition, Southeast Asians are often poorly educated about hypoglycemia and its management, including during Ramadan fasting. We conclude there is a need for more information about Southeast Asian populations with diabetes to assist with the construction of more appropriate national and regional guidelines for the management of hypoglycemia, more closely aligned to patient demographics, behaviors and treatment practices. Such bespoke guidelines might result in a greater degree of implementation and adherence within clinical practice in Southeast Asian nations.
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Affiliation(s)
- Su-Yen Goh
- Department of Endocrinology, Singapore General Hospital, Singapore
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Deeb A, Al Qahtani N, Akle M, Singh H, Assadi R, Attia S, Al Suwaidi H, Hussain T, Naglekerke N. Attitude, complications, ability of fasting and glycemic control in fasting Ramadan by children and adolescents with type 1 diabetes mellitus. Diabetes Res Clin Pract 2017; 126:10-15. [PMID: 28189949 DOI: 10.1016/j.diabres.2017.01.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 01/06/2017] [Accepted: 01/20/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Sick individuals and children are exempted from fasting Ramadan. Fasting by type 1 diabetes patients might predispose to acute complications. There are no guidelines on fasting safety or its impact on diabetes control in children and adolescents. We aim to assess patients' attitude towards fasting, frequency of complications and impact on glycemic control in children with type 1 diabetes. RESEARCH DESIGN & METHODS 65 children with type 1 diabetes were enrolled. The study involved 2 hospital visits. Questionnaires were filled in each visit and HbA1c was recorded. Log books indicating symptomatic hypoglycemia and hyperglycemia leading to breaking fast were obtained. RESULTS Majority of subjects were willing to fast and 75% were encouraged by parents to do. 57% and 26% fasted more than half and all through the month respectively. 52% had, at least, one episode of hypoglycemia and 29% had hyperglycemia with one episode of ketoacidosis. All patients broke fast in response to symptomatic hypoglycemia/hyperglycemia. There was no significant difference between the frequency of complications in the pump or the Multiple Daily Injection (MDI) groups. Mean HbA1c increased from 70mmol/mol to 73mmol/mol. The difference was not statistically significant. CONCLUSION Children and adolescents with type 1 diabetes are keen to fast Ramadan and they are able to fast a significant number of days. Hypoglycemia and hyperglycemia are not uncommon with no difference between Pump or in MDI users. Breaking fast on occurrence of complications makes fasting safe. Glycemic control might deteriorate during the month and the following Eid.
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Affiliation(s)
- Asma Deeb
- Paediatric Endocrinology Department, Mafraq Hospital, AbuDhabi, United Arab Emirates.
| | - Nabras Al Qahtani
- Paediatric Endocrinology Department, Mafraq Hospital, AbuDhabi, United Arab Emirates
| | - Mariette Akle
- Paediatric Endocrinology Department, Mafraq Hospital, AbuDhabi, United Arab Emirates
| | - Himanshi Singh
- Medical School, Gulf University, Ajman, United Arab Emirates
| | - Rifah Assadi
- Medical School, Gulf University, Ajman, United Arab Emirates
| | - Salima Attia
- Paediatric Endocrinology Department, Mafraq Hospital, AbuDhabi, United Arab Emirates
| | - Hana Al Suwaidi
- Paediatric Endocrinology Department, Mafraq Hospital, AbuDhabi, United Arab Emirates
| | - Tara Hussain
- Paediatric Endocrinology Department, Mafraq Hospital, AbuDhabi, United Arab Emirates
| | - Nico Naglekerke
- Institute of Public Health, Emirates University, Al Ain, United Arab Emirates
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Culture, Race, and Ethnicity Issues in Health Care. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lee JY, Wong CP, Tan CSS, Nasir NH, Lee SWH. Type 2 diabetes patient's perspective on Ramadan fasting: a qualitative study. BMJ Open Diabetes Res Care 2017; 5:e000365. [PMID: 28761651 PMCID: PMC5530234 DOI: 10.1136/bmjdrc-2016-000365] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 02/15/2017] [Accepted: 03/27/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We evaluated the beliefs, experience and diabetes management strategies of type 2 diabetes mellitus (T2DM) Muslim patients that chose to fast during Ramadan. RESEARCH DESIGN AND METHODS A semistructured focus group interview was conducted with 53 participants with T2DM. Participants were purposefully sampled and asked to share their perspective on Ramadan fasting. All interviews were audio recorded, transcribed verbatim and analyzed thematically. RESULTS Participants reported optimism towards fasting during Ramadan, as they believed that fasting was beneficial to their overall well-being, and a time for family bonding. Most participants made limited attempts to discuss with their doctors on the decision to fast and self-adjusted their medication based on experience and symptoms during this period. They also reported difficulty in managing their diet, due to fear of hypoglycemia and the collective social aspect of fasting. CONCLUSION Muslims are optimistic about their well-being when fasting during Ramadan. Many choose to fulfill their religious obligation despite being discouraged by their doctors. Collaboration with religious authorities should be explored to ensure patients receive adequate education before fasting during Ramadan. TRIAL REGISTRATION NUMBER NCT02189135; Results.
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Affiliation(s)
- Jun Yang Lee
- School of Pharmacy, Monash University, Subang Jaya, Selangor, Malaysia
| | - Chee Piau Wong
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Christina San San Tan
- School of Allied Health Sciences, SEGi University and Colleges, Petaling Jaya, Selangor, Malaysia
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Alabbood MH, Ho KW, Simons MR. The effect of Ramadan fasting on glycaemic control in insulin dependent diabetic patients: A literature review. Diabetes Metab Syndr 2017; 11:83-87. [PMID: 27402028 DOI: 10.1016/j.dsx.2016.06.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/28/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Ramadan fasting is one of the five pillars of Islam. People with diabetes are exempted from fasting according to Islamic rules. However, many people with diabetes wish to fast. Physicians are asked frequently by their patients about their ability to fast and the possible impact of fasting on their glycaemic control. Studies about the effect of Ramadan on people with insulin-treated diabetes are scarce. This review aims to provide clinicians with the best recommendations for their patients with insulin-treated diabetes who wish to fast. METHODS Four databases (Medline, EMBASE, Scopus and PubMed) were searched using the following MeSH terms and keywords: "insulin dependent diabetes mellitus", "type 1 diabetes mellitus", 'Ramadan' "and" "fasting". In addition, a hand search of key journals and reference lists was performed. Sixteen full text articles were selected for review and critical analysis. RESULTS All of the included studies except one found improvement or no change in glycaemic control parameters during Ramadan fasting. The incidence of major complications were negligible. Minor hypoglycaemic events were reported in some studies but did not adversely affect fasting. Postprandial hyperglycaemia was a major concern in other studies. However, the incidence of severe hyperglycaemia and diabetic ketoacidosis were trivial. CONCLUSION Ramadan fasting is feasible for insulin dependent diabetic patient who wish to fast. Clinicians should advise their patients about the importance of adequate glycaemic control before Ramadan and frequent glucose monitoring during fasting. Certain types of Insulin seem to be more beneficial than other.
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Affiliation(s)
- Majid H Alabbood
- Faculty of Medicine and Health Sciences/Macquarie University; Basra Medical College, Basra, Iraq.
| | - Kenneth W Ho
- Faculty of Medicine and Health Sciences/Macquarie University
| | - Mary R Simons
- Faculty of Medicine and Health Sciences/Macquarie University
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Noon MJ, Khawaja HA, Ishtiaq O, Khawaja Q, Minhas S, Niazi AK, Minhas AMK, Malhi UR. Fasting with diabetes: a prospective observational study. BMJ Glob Health 2016; 1:e000009. [PMID: 28588932 PMCID: PMC5321331 DOI: 10.1136/bmjgh-2015-000009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 07/08/2016] [Accepted: 07/12/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the proportion of diabetic patients who develop adverse glycaemic events when fasting regularly. DESIGN Prospective observational study conducted at a tertiary care hospital in South Asia. Five hundred and twenty-three patients were assessed for eligibility, and 150 were included in the final analysis. Diabetic patients over 18 years of age who were willing to fast regularly and make a chart of their daily blood sugar levels were included in the study. The main outcome measures were hypoglycaemic and hyperglycaemic events. Frequencies and percentages were calculated for quantitative variables, while mean±SD were documented for qualitative variables. Relative risk was calculated as a measure of association. RESULTS Of a total of 150 individuals, 10% experienced hypoglycaemia, while 3.3% reported hyperglycaemic episodes. Only 8.7% of the participants discontinued one or more fasts; however, none of them required hospitalisation. There is a negative association between a visit to a physician by diabetic patients before they begin to fast regularly and the risk of developing hypoglycaemia (relative risk 0.73). CONCLUSIONS Many diabetic patients who fast regularly are at high risk of adverse glycaemic events. Most diabetics do not consult their physicians before fasting to adjust medications and lifestyle. Various strategies should be planned and implemented for the awareness and education of such patients to avoid adverse glycaemic events and subsequent complications.
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Affiliation(s)
- Muhammad Jawad Noon
- Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | | | - Osama Ishtiaq
- Department of Endocrinology, Shifa International Hospital, Islamabad, Pakistan
| | | | - Sana Minhas
- Shifa International Hospital, Islamabad, Pakistan
| | - Asfandyar Khan Niazi
- Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
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Elbarbary NS. Effectiveness of the low-glucose suspend feature of insulin pump during fasting during Ramadan in type 1 diabetes mellitus. Diabetes Metab Res Rev 2016; 32:623-33. [PMID: 26789012 DOI: 10.1002/dmrr.2781] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 12/18/2015] [Accepted: 01/04/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Severe hypoglycaemia during the daytime of Ramadan fasting is a highly feared complication. In a prospective study, we investigated the effect of the low-glucose suspend (LGS) algorithm on the frequency of hypoglycaemia in adolescents with T1DM who wished to fast during Ramadan. SUBJECTS AND METHODS Sixty patients (19 males and 41 females, 15.6 ± 2.7 years, duration of diabetes 5.8 ± 2.9 years, pump therapy for 1.73 ± 0.99 years, used the Paradigm(®) Veo(™) System (Medtronic) and were divided into two groups: first (n=25), those who used the sensor with low-glucose suspend (LGS) feature and second (n = 35), those who used the sensor but turned off low-glucose suspend (LGS) feature. RESULTS A total of 2716 LGS alerts occurred, and 48.6% began in the afternoon between 4pm and 7pm. The mean duration of LGS events was 26.5 min, 38% lasted for <5 min and 5.3% lasted for 120 min. Among these episodes, the mean sensor glucose was 62.3 ± 5.96 mg/dL at LGS activation, rose to 129.8 ± 11.6 mg/dL by the end of the LGS episode (when insulin delivery was automatically resumed) and was 155.6 ± 11.1 mg/dL at 240 min. LGS usage significantly reduced area under the curve (AUC) <70, AUC <60 mg/dL (p = 0.0001) and >240 mg/dL (p = 0.006). None of the LGS-on group broke their fast versus 15 in the second group (p = 0.001). No episodes of severe hyperglycaemia or DKA were noticed in either groups. CONCLUSIONS Usage of low-glucose suspend (LGS) significantly reduced exposure to hypoglycaemia without compromising safety. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Nancy Samir Elbarbary
- Department of Pediatrics, Pediatric Diabetes Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Al Sifri S, Rizvi K. Filling the Knowledge Gap in Diabetes Management During Ramadan: the Evolving Role of Trial Evidence. Diabetes Ther 2016; 7:221-40. [PMID: 27091198 PMCID: PMC4900978 DOI: 10.1007/s13300-016-0168-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Indexed: 12/14/2022] Open
Abstract
UNLABELLED Muslim patients with type 2 diabetes (T2D) who fast during Ramadan face challenges in diabetes management due to substantial alterations in lifestyle and treatment that frequently accompany the decision to fast. International guidelines for treating T2D do not fully address the clinical issues unique to fasting, and other guidance documents lack the large and high-quality evidence base available for non-fasting conditions. We reviewed 10 randomized controlled trials and 20 observational studies in T2D during Ramadan to assess the quality of evidence and identify issues in trial design that should be addressed in future studies. Results indicated that heterogeneity in key aspects of trial design precluded meaningful comparisons across studies. These included patients' baseline treatment at entry; use of a cutoff for glycemic control [glycated hemoglobin (HbA1c)] for eligibility; exclusion of patients with a history of recurrent hypoglycemia or hypoglycemia unawareness, or with other serious systemic diseases; duration of treatment and follow-up, selection of safety versus efficacy as primary end point; and definition and measurement of those end points. Fructosamine was rarely used as an efficacy end point, despite the advantage of reflecting glycemic control over a period more closely aligned with the duration of Ramadan fasting than HbA1c. Adherence to treatment, definition and adherence to fasting, and changes in diet and exercise were reported inconsistently, and when reported, not in a fashion that would allow adequate control of confounding due to these variables. Despite a large body of evidence demonstrating their safety and efficacy in non-fasting populations, only two trials reported data for glucagon-like peptide-1 analogs, and neither involved a head-to-head comparison against dipeptidyl peptidase-4 inhibitors. More rigorous studies using trial designs suited to the unique conditions of a fasting population and capturing both standardized efficacy and safety end points are needed to provide better guidance to optimal treatment of T2D during Ramadan fasting. FUNDING Novo Nordisk AG.
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Affiliation(s)
- Saud Al Sifri
- Endocrinology Department, Alhada Military Hospital, Taif, Saudi Arabia.
| | - Kashif Rizvi
- Specialized British Medical Unit, Mazaya Clover Centre, Jabriya, Kuwait
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Loh HH, Yee A, Loh HS, Sukor N, Kamaruddin NA. Comparative studies of dipeptidyl peptidase 4 inhibitor vs sulphonylurea among Muslim Type 2 diabetes patients who fast in the month of Ramadan: A systematic review and meta-analysis. Prim Care Diabetes 2016; 10:210-219. [PMID: 26392074 DOI: 10.1016/j.pcd.2015.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/02/2015] [Accepted: 09/03/2015] [Indexed: 12/21/2022]
Abstract
AIM To systematically review the literature to compare the use of DPP4 inhibitors vs sulphonylurea in type 2 diabetic Muslim patients who fast in Ramadan, with regards to its safety, tolerability, glycemic control, and body weight changes. METHODS All English-language medical literature published from inception till October 2014 which met the inclusion criteria were reviewed and analyzed. RESULTS A total of nine papers were included, reviewed and analyzed. The total sample size was 4276 patients. All studies used either of the two DPP4 inhibitors - Vildagliptin or Sitagliptin, vs sulphonylurea or meglitinides. Patients receiving DPP4 inhibitors were less likely to develop symptomatic hypoglycemia (risk ratio 0.46; 95% CI, 0.30-0.70), confirmed hypoglycemia (risk ratio 0.36; 95% CI, 0.21-0.64) and severe hypoglycemia (risk ratio 0.22; 95% CI, 0.10-0.53) compared with patients on sulphonylureas. There was no statistically significant difference in HbA1C changes comparing Vildagliptin and sulphonylurea. CONCLUSION DPP4 inhibitor is a safer alternative to sulphonylurea in Muslim patients with type 2 diabetes mellitus who fast during the month of Ramadan as it is associated with lower risk of symptomatic, confirmed and severe hypoglycemia, with efficacy comparable to sulphonylurea.
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Affiliation(s)
- Huai Heng Loh
- Faculty of Medicine and Health Sciences, University of Malaysia Sarawak, Jalan Datuk Mohd Musa, 94300 Kota Samarahan, Sarawak, Malaysia.
| | - Anne Yee
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Huai Seng Loh
- Clinical Academic Unit, Newcastle University Medicine Malaysia, No. 1, Jalan Sarjana 1, Kota Ilmu, Educity@Iskandar, 79200 Nusajaya, Johor, Malaysia
| | - Norlela Sukor
- Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, Malaysia
| | - Nor Azmi Kamaruddin
- Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, Malaysia
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Tourkmani AM, Hassali MA, Alharbi TJ, Alkhashan HI, Alobikan AH, Bakhiet AH, Alqahtani HB, Alrasheedy AA, Alawwad AD, Mishriky AM, Aljadhey H. Impact of Ramadan focused education program on hypoglycemic risk and metabolic control for patients with type 2 diabetes. Patient Prefer Adherence 2016; 10:1709-17. [PMID: 27660420 PMCID: PMC5019439 DOI: 10.2147/ppa.s113324] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Fasting during the month of Ramadan could lead to acute complications and increased hypoglycemic risk of patients with type 2 diabetes. Therefore, diabetes is one of the diseases that need careful observation and special considerations during Ramadan including patients' education and counseling. OBJECTIVES To evaluate the impact of Ramadan focused education program on acute complications and biomedical parameters. METHODS A prospective nonrandomized interventional controlled design was run on three phases: before, during, and after Ramadan on 262 type 2 diabetes patients. The intervention group (n=140) received focused individualized diabetic education sessions and antidiabetic medications adjustment before and after Ramadan, while the control group (n=122) received standard diabetic care. A validated hypoglycemia questionnaire was used in both groups to assess the change of the risk. Patients were advised to adjust the dosage and timing of antidiabetic agents according to the recommendations for management of diabetes during Ramadan. Primary outcomes were postintervention change of hypoglycemia score and HbA1c over 6-month follow-up. Data were presented as mean ± standard deviation. HbA1c was expressed in percentage. RESULTS The hypoglycemic scores before, during, and after Ramadan were 14.21±8.50, 6.36±6.17, and 5.44±5.55 in the intervention group, respectively (P<0.001) and 14.01±5.10, 13.46±5.30, and 9.27±4.65 in the control group, respectively (P<0.001). HbA1c levels were 9.79±1.89, 8.26±1.54, and 8.52±1.61 before, during, and after Ramadan in the intervention group, respectively (P<0.001), and 10.04±1.47, 9.54±1.38, and 9.59±1.79 in the control group, respectively (P<0.001). Post-Ramadan reductions of HbA1c and hypoglycemic scores were significantly higher in the intervention group (-13.0% vs -4.5%, P=0.004 for HbA1c and -61.7% vs -33.8%, P<0.001 for hypoglycemic score). Low-density lipoprotein cholesterol improved in the intervention group from 2.41±0.91 mmol/L before Ramadan to 2.28±0.68 mmol/L after Ramadan (P<0.001). No statistically significant effects were observed on blood pressure or body weight in the intervention group. Also, no change was observed in the control group. CONCLUSION Ramadan educational program had a positive impact with reduction of hypoglycemic risk, HbA1c, and low-density lipoprotein cholesterol. Therefore, it could be recommended for patients with increased risk of hypoglycemia during Ramadan fasting.
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Affiliation(s)
- Ayla M Tourkmani
- Family and Community Medicine Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- Correspondence: Ayla M Tourkmani, Family and Community Medicine Department, Prince Sultan Military Medical City, PO Box 1749, Riyadh 11441, Saudi Arabia, Tel +966 1 50 291 2221, Email
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Turki J Alharbi
- Family and Community Medicine Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hesham I Alkhashan
- Family and Community Medicine Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Aljoharah H Alobikan
- Family and Community Medicine Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ahmed H Bakhiet
- Family and Community Medicine Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hala B Alqahtani
- Family and Community Medicine Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Alian A Alrasheedy
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Qassim Saudi Arabia
| | - Ahmed D Alawwad
- Family and Community Medicine Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Adel M Mishriky
- Family and Community Medicine Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hisham Aljadhey
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Shehadeh N, Maor Y. Effect of a new insulin treatment regimen on glycaemic control and quality of life of Muslim patients with type 2 diabetes mellitus during Ramadan fast - an open label, controlled, multicentre, cluster randomised study. Int J Clin Pract 2015; 69:1281-8. [PMID: 26234442 DOI: 10.1111/ijcp.12695] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 06/06/2015] [Indexed: 11/28/2022] Open
Abstract
We performed a non-inferiority trial comparing insulin detemir (Levemir) and biphasic insulin (NovoMix70) to standard care during Ramadan fast in insulin treated type 2 diabetes mellitus (T2DM) patients. This was an open label, controlled, multicentre, cluster randomised non-inferiority study. Insulin treated T2DM patients from 12 randomly selected primary clinics received Levemir and NovoMix 70 (intervention, n = 127) or standard care according to the American Diabetes Association recommendations (control, n = 118). Insulin dose (intervention) was 60% of the usual, of this 40% was dosed as Levemir at sunrise and 60% as NovoMix 70 before dinner. Insulin was titrated according to daily 4 point self-measured blood glucose (4P-SMBG) levels. The primary outcome was the difference in mean daily 4P-SMBG during days 23-30 of treatment. Mean age was 60.1 (SD 8.9) and 59.4 (SD 10.1) years in the intervention and control respectively. Mean HbA1c was 8.38% (68 mmol/mol) (SD 0.96) and 8.45% (69 mmol/mol) (SD 1.08). Mean BMI was 32.99 (SD 7.05) and 33.08 (SD 7.24), respectively. The intervention was non-inferior to standard care as assessed by mean 4P-SMBG during days 23-30 of treatment [155 (SD 30.76) mg% and 159 (SD 33.24) mg% respectively, p = 0.269]. Adverse event rate was significantly lower in the intervention group [0.04 (SD 0.06) vs. 0.07 (SD 0.11), p = 0.010]. In particular, hypoglycaemia event rate was lower in the intervention group [0.00 (SD 0.01) vs. 0.01 (SD 0.03), p ≤ 0.001]. To conclude, treatment with Levemir and NovoMix 70 was non-inferior to standard care in this heterogeneous group of patients and was associated with less adverse events.
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Affiliation(s)
- N Shehadeh
- Diabetes Clinic, Clalit Medical Services and the Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Y Maor
- Infectious Disease Unit, Wolfson Medical Center, Tel Aviv University, Holon, Israel
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Kalra S, Aamir AH, Raza A, Das AK, Azad Khan AK, Shrestha D, Qureshi MF, Md Fariduddin, Pathan MF, Jawad F, Bhattarai J, Tandon N, Somasundaram N, Katulanda P, Sahay R, Dhungel S, Bajaj S, Chowdhury S, Ghosh S, Madhu SV, Ahmed T, Bulughapitiya U. Place of sulfonylureas in the management of type 2 diabetes mellitus in South Asia: A consensus statement. Indian J Endocrinol Metab 2015; 19:577-96. [PMID: 26425465 PMCID: PMC4566336 DOI: 10.4103/2230-8210.163171] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Since their introduction in clinical practice in the 1950's, Sulfonylureas (SUs) have remained the main-stay of pharmacotherapy in the management of type 2 diabetes. Despite their well-established benefits, their place in therapy is inappropriately being overshadowed by newer therapies. Many of the clinical issues associated with the use of SUs are agent-specific, and do not pertain to the class as such. Modern SUs (glimepiride, gliclazide MR) are backed by a large body of evidence, experience, and most importantly, outcome data, which supports their role in managing patients with diabetes. Person-centred care, i.e., careful choice of SU, appropriate dosage, timing of administration, and adequate patient counseling, will ensure that deserving patients are not deprived of the advantages of this well-established class of anti-diabetic agents. Considering their efficacy, safety, pleiotropic benefits, and low cost of therapy, SUs should be considered as recommended therapy for the treatment of diabetes in South Asia. This initiative by SAFES aims to encourage rational, safe and smart prescription of SUs, and includes appropriate medication counseling.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
| | - A H Aamir
- Department of Endocrinology, Post Graduate Medical Institute Hayatabad Medical Complex, Peshawar, Pakistan
| | - Abbas Raza
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - A K Das
- Department of Endocrinology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - A K Azad Khan
- Department of Public Health, Bangladesh University of Health Sciences, Dhaka, Bangladesh
| | - Dina Shrestha
- Department of Endocrinology, Norvic International Hospital, Kathmandu, Nepal
| | - Md Faisal Qureshi
- Department of Endocrinology, Al-Khaliq Medicare Hospital, Dhaka, Bangladesh
| | - Md Fariduddin
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | | | - Fatema Jawad
- Department of Diabetology, Medilink Clinics, Karachi, Pakistan
| | - Jyoti Bhattarai
- Department of Medicine, Trivuvan University, Kathmandu, Nepal
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Noel Somasundaram
- South Asian Federation of Endocrine Societies, National Hospital, Dhaka, Bangladesh
| | - Prasad Katulanda
- Department of Clinical Medicines, Diabetes Research Unit, University of Colombo, Colombo, Sri Lanka
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, Telangana, India
| | - Sanjib Dhungel
- Department of Medicine, Nepal Medical College Teaching Hospital, Kathmandu, Nepal
| | - Sarita Bajaj
- Department of Medicine, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - Subhankar Chowdhury
- Department of Endocrinology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, IPGMER, Kolkata, West Bengal, India
| | - S V Madhu
- Department of Medicine and Head, Centre for Diabetes, Endocrinology and Metabolism, UCMS-GTB Hospital, New Delhi, India
| | - Tofail Ahmed
- Department of Endocrinology, BIRDEM, Dhaka, Bangladesh
| | - Uditha Bulughapitiya
- Department of Endocrinology, Kalubowila South Teaching Hospital, Kalubowila, Sri Lanka
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Yeoh ECK, Zainudin SB, Loh WN, Chua CL, Fun S, Subramaniam T, Sum CF, Lim SC. Fasting during Ramadan and Associated Changes in Glycaemia, Caloric Intake and Body Composition with Gender Differences in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2015. [DOI: 10.47102/annals-acadmedsg.v44n6p202] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: Millions of Muslim patients with diabetes mellitus (DM) fast during Ramadan. However, little is known about the metabolic impact of Ramadan fasting. We aimed to study the changes in body composition and metabolic profile in this group of patients. Materials and Methods: We studied 29 Southeast Asian Muslim patients with type 2 diabetes; all underwent pre-Ramadan education. Study variables were weight change, body composition (using multifrequency bioimpedance method, InBody S20®, Biospace, South Korea), blood pressure (BP), glycated haemoglobin (HbA1c), fasting lipid profile, and caloric intake assessment using FoodWorks® nutrient analysis software. Results: Twenty-three subjects fasted ≥15 days; mean ± SD: 57 ± 11 years; 52% were males. HbA1c improved significantly (8.6 ± 2.4% pre-Ramadan vs 8.0 ± 2.3% end-Ramadan, P= 0.017). Despite similar body weight, there was reduction in body fat mass (BFM) (30.9 ± 11 kg vs 29.2 ± 12.2 kg, P = 0.013). Multivariate analysis suggested that the reduction in HbA1c was attributed by reduction in BFM (β = -0.196, P = 0.034). There was no change in visceral adiposity (visceral fat area (VFA)) but stratification by gender showed a reduction amongst females (137.6 ± 24.5 cm2 to 132.5 ± 25.7 cm2, P = 0.017). These changes occurred despite similar total caloric intake (1473.9 ± 565.4 kcal vs 1473.1 ± 460.4 kcal, P = 0.995), and proportion of carbohydrate (55.4 ± 6.3% vs 53.3 ± 7.5%, P = 0.25) and protein intake (17.6 ± 4.1% vs 17.3 ± 5.4%, P = 0.792), before and during Ramadan respectively, but with increased proportion of fat intake (11.9 ± 2.4% vs 13 ± 11.7%, P = 0.04). Seven out of 23 patients had medications adjusted to avert symptomatic hypoglycaemia but none of the patients developed severe hypoglycaemia. Conclusion: Ramadan fasting can be practiced safely with prior patient education and medication adjustment. It also confers modest benefits on metabolic profile and body composition, especially among females.
Key words: Diabetes, Education, Muslims
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Affiliation(s)
| | | | | | | | - Sharon Fun
- Diabetes Centre, Khoo Teck Puat Hospital, Singapore
| | | | | | - Su Chi Lim
- Diabetes Centre, Khoo Teck Puat Hospital, Singapore
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50
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Culture, Race, and Ethnicity Issues in Healthcare. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_3-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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