A prospective multi-country observational trial to compare the incidences of diabetic ketoacidosis in the month of Ramadan, the preceding month, and the following month (DKAR international)

Background

1.7 billion Muslims worldwide obey divine commands of fasting for a month. This may increase the probability of the acute complications of diabetes during the fasting period.

Design and methods

We primarily aimed to compare the incidences and duration of Diabetic ketoacidosis (DKA) admissions during Ramadan compared to the month before (Shaaban) and the month after (Shawal) as well as the average pre-Ramadan six months' admissions. Our secondary objective was to assess the different incidence of DKA between Ramadan and the other months regarding precipitating factors, fasting practices in people admitted with DKA and gender differences.

This was a prospective study that included all Muslims who were admitted with DKA to major hospitals in the United Arab Emirates, Sudan, Tunisia and Morocco during the pre-Ramadan month, Ramadan and post-Ramadan month, in addition to the average monthly admissions during the last six months before Ramadan. Demographics, clinical, and laboratory indices were collected and analyzed to assess primary and secondary end points.

Results

One hundred seventy patients were admitted during the study duration, 56 were admitted during Ramadan and 63 in Shawal. Six months before Ramadan showed an average admission of 56 + 7 per month. All those admitted during Ramadan were people with type1 diabetes. 29.8 % of those admitted during Ramadan did not receive structured education program on diabetes management in Ramadan. Non-compliance to medications represented the commonest cause for admission in the whole study period. Hospital stay was comparable through different months, but the duration of acidosis was longest during Ramadan month.

Conclusion

In concordance with DKAR1, DKAR international showed higher rates of DKA during Ramadan when compared to preceding Lunar month (Shaaban). In Shawal, however, the rates of DKA admission were higher than the average monthly DKA admissions. The duration of acidosis was longer in Ramadan group and positively correlated with duration of diabetes. Many patients did not receive structured education about diabetes and fasting Ramadan. Our study calls for formal pre-Ramadan education and enforces the need for advice against fasting in patients who already experienced DKA in the months preceding Ramadan.

Clinical experience with insulin detemir, biphasic insulin aspart and insulin aspart in people with type 2 diabetes: Results from the Marrakech cohort of the A1chieve study

BACKGROUND

The A1chieve, a multicentric (28 countries), 24-week, non-interventional study evaluated the safety and effectiveness of insulin detemir, biphasic insulin aspart and insulin aspart in people with T2DM (n = 66,726) in routine clinical care across four continents.

MATERIALS AND METHODS

Data was collected at baseline, at 12 weeks and at 24 weeks. This short communication presents the results for patients enrolled from Marrakech, Morocco.

RESULTS

A total of 196 patients were enrolled in the study. Four different insulin analogue regimens were used in the study. Study patients had started on or were switched to biphasic insulin aspart (n = 71), insulin detemir (n = 83), insulin aspart (n = 5), basal insulin plus insulin aspart (n = 14) and other insulin combinations (n = 23). At baseline glycaemic control was poor for both insulin naïve (mean HbA1c: 9.3%) and insulin user (mean HbA1c: 9.3%) groups. After 24 weeks of treatment, both the study groups showed improvement in HbA1c (insulin naïve: -2.3%, insulin users: -1.9%). SADR's including major hypoglycaemic events did not occur in any of the study patients.

CONCLUSION

Starting or switching to insulin analogues was associated with improvement in glycaemic control with a low rate of hypoglycaemia.