Background: Poorly controlled diabetic patients (PCDP) are at increased risk during Ramadan fasting. International guidelines caution against Ramadan fasting among PCDP. However, many PCDP fast against medical advice. To our knowledge, no studies have specifically addressed the safety of Ramadan fasting by PCDP and hence, we aimed to study this.
Methods: Adults with type 2 DM attending a tertiary hospital’s Endocrinology clinic, who had fasted for at least 2 weeks in Ramadan, were evaluated. The safety and biochemical parameters were compared between the 2 groups based on pre- Ramadan glycemic control-Group 1 (HbA1c <9%) and group 2 (PCDP, HbA1C ≥ 9%).
Results: We evaluated 139 Ramadan fasts by 113 participant-70 fasts were by PCDP, of which 26 were studied twice (2016 and 2017). The results are summarised below.
Hypoglycemia was more frequent in group 1 compared to PCDP (p = 0.017). However, there was no significant difference in other safety parameters between both groups. None of the PCDP suffered from hyperglycemia related complications.
Conclusion: Most of the PCDP in our cohort were able to fast safely during Ramadan. Our findings need to be confirmed with prospective studies in different ethnic and geographic settings. PCDP with no prior hyperglycemic crisis can fast during Ramadan safely if specific education is offered and may even harness the beneficial effects of Ramadan such as metabolic memory.
| Characteristics | Group 1 (N = 69; mean HbA1c 7.8%) | Group 2 (N = 70; mean HbA1c 10.8%) |
| No. of days fasted (Mean) | 26.9 | 27.7 |
| Polydipsia (N) | 8 | 13 |
| Hypoglycemia (N) | 14 | 9 |
| Hyperglycemia (capillary blood glucose > 16 mmol/L, N) | 9 | 12 |
| Need to break fast due to hypoglycemia (N) | 14 | 9 |
| Need to break fast due to hyperglycemia (N) | 0 | 0 |
| Hyperglycemic crisis/ DM related hospital admissions (N) | 0 | 0 |
| Mean HbA1c change (%) pre and post-Ramadan | + 0.18 | - 0.28 |
| Characteristics | Group 1 (N = 69; mean HbA1c 7.8%) | Group 2 (N = 70; mean HbA1c 10.8%) |
| No. of days fasted (Mean) | 26.9 | 27.7 |
| Polydipsia (N) | 8 | 13 |
| Hypoglycemia (N) | 14 | 9 |
| Hyperglycemia (capillary blood glucose > 16 mmol/L, N) | 9 | 12 |
| Need to break fast due to hypoglycemia (N) | 14 | 9 |
| Need to break fast due to hyperglycemia (N) | 0 | 0 |
| Hyperglycemic crisis/ DM related hospital admissions (N) | 0 | 0 |
| Mean HbA1c change (%) pre and post-Ramadan | + 0.18 | - 0.28 |
Y. Chee: None. S. Ng: None. K.J. Kwek: None. S. Abdul Shakoor: None.
