Evaluation of glycaemic control and diabetes treatment strategies during the religious fasting period of Ramadan

摘要

Ramadan is one of the longest periods of religious fasting. Muslims abstain fromudfood and drink from sunrise to sunset for the month of Ramadan. In patients withuddiabetes, dietary changes during Ramadan can influence the glycaemic control.udSince Ramadan is a key part of the Islamic faith, many Muslims with diabetes areudwilling to endure the hardship and choose to fast.udThe thesis included discussions on the physiology and the practice of fasting inuddifferent religious groups. The current evidence for the optimum diabetesudmanagement during Ramadan was reviewed and recommendations were madeudbased on randomised, comparison and observational studies and expert consensus.udThe practice of fasting among pregnant women with diabetes was assessed in NorthudWest London in a questionnaire-based survey. Only 10% of women fasted. Havinguddiabetes and hypoglycaemia were the likely deterrent factors. Imams (religiousudadvisors) were as important as healthcare professionals in advising about fasting.udThe glycaemic variability in patients with diabetes who followed theudrecommendations for optimal diabetes management was studied using continuousudglucose monitoring. The glycaemic variability during fasting and non-fasting periodsudof Ramadan was similar, suggesting that pre-Ramadan assessment was useful inudnegating glycaemic excursions during Ramadan.udChanging to Humalog Mix 50 insulin at Iftar (sunset meal) in type 2 diabetes patientsudthat were on twice daily Human Mixtard 30 insulin minimised their risk ofudhypoglycaemia without compromising their glycaemic control during Ramadan. Theudincretin-based therapies were more suitable than gliclazide when considering anudadd-on to metformin for type 2 diabetes patients who planned to fast for Ramadan.udIn summary, the main aim of pre-Ramadan assessment and therapeutic adjustmentsudis to allow patients with type 2 diabetes to fast safely during Ramadan.