A Population-Based Study of Diabetes and Its Characteristics During the Fasting Month of Ramadan in 13 Countries

TLDR

The study aims to evaluate diabetes characteristics and care during Ramadan across 13 countries and to highlight the need for intensified pre‑fasting education and guideline dissemination. A population‑based, retrospective, cross‑sectional survey of 12,914 diabetic patients (12,243 analyzed) was conducted across 13 countries using stratified sampling. Among 12,243 participants, 8.7 % had type 1 and 91.3 % type 2 diabetes; 42.8 % of type 1 and 78.7 % of type 2 patients fasted ≥15 days, yet less than half altered medication doses, and severe hypoglycemia rates rose markedly during Ramadan—especially in those who modified doses or activity—underscoring the challenge for clinicians.

Abstract

OBJECTIVE—The aim of this study was to assess the characteristics and care of patients with diabetes in countries with a sizable Muslim population and to study diabetes features during Ramadan and the effect of fasting. RESEARCH DESIGN AND METHODS—This was a population-based, retrospective, transversal survey conducted in 13 countries. A total of 12,914 patients with diabetes were recruited using a stratified sampling method, and 12,243 were considered for the analysis. RESULTS—Investigators recruited 1,070 (8.7%) patients with type 1 diabetes and 11,173 (91.3%) patients with type 2 diabetes. During Ramadan, 42.8% of patients with type 1 diabetes and 78.7% with type 2 diabetes fasted for at least 15 days. Less than 50% of the whole population changed their treatment dose (approximately one-fourth of patients treated with oral antidiabetic drugs [OADs] and one-third of patients using insulin). Severe hypoglycemic episodes were significantly more frequent during Ramadan compared with other months (type 1 diabetes, 0.14 vs. 0.03 episode/month, P = 0.0174; type 2 diabetes, 0.03 vs. 0.004 episode/month, P < 0.0001). Severe hypoglycemia was more frequent in subjects who changed their dose of OADs or insulin or modified their level of physical activity. CONCLUSIONS—The large proportion of both type 1 and type 2 diabetic subjects who fast during Ramadan represent a challenge to their physicians. There is a need to provide more intensive education before fasting, to disseminate guidelines, and to propose further studies assessing the impact of fasting on morbidity and mortality.