Diabetes Canada Position Statement for People With Types 1 and 2 Diabetes Who Fast During Ramadan

Bajaj, Harpreet S.; Abouhassan, Tyceer; Ahsan, Muhammad R; Arnaout, Amel; Hassanein, Mohamed; Houlden, Robyn L.; Khan, Talat; Khandwala, Hasnain; Verma, Subodh

doi:10.1016/j.jcjd.2018.04.007

Cited by 34 publications

(31 citation statements)

References 42 publications

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“…The IDF-DAR guidelines recommend that people with T2DM who are at 'very high-' or 'high-risk' should not fast during Ramadan [6]; regional advice on this topic from Diabetes Canada is in line with IDF-DAR recommendations [14]. This recommendation was not strictly adhered to, as 14.3% of participants in ORION (which specifically recruited participants who intended to fast during Ramadan) were at high risk and 2.9% at very high risk; however the majority were at moderate/low-risk (82.8%).…”

Section: Discussionmentioning

confidence: 97%

“…Events of severe and/or symptomatic documented hypoglycaemia at the 70 mg/dL SMPG threshold were recorded in 13 participants during the Ramadan period, with most events occurring during fasting hours of the day. Around half of the participants reporting those events were from Canada; the disproportionately large number of events recorded in Canada is likely due to the extended day length, in which fasting hours can last 18 h or more, potentially increasing the risk of hypoglycaemia [14]. For example, fasting hours in 2019 were approximately 02:59 am to 09:43 pm (18 h, 44 min) in Edmonton, Canada [15], compared with 03:38 am to 06:35 pm (14 h 57 min) in Riyadh, Saudi Arabia [16].…”

Section: Discussionmentioning

confidence: 99%

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Real-world safety and effectiveness of insulin glargine 300 U/mL in participants with type 2 diabetes who fast during Ramadan: The observational ORION study

Hassanein

Büyükbeşe²,

Malek

et al. 2020

Diabetes Research and Clinical Practice

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ORION evaluated the safety and effectiveness of Gla-300 in insulin-treated people with T2DM before, during and after Ramadan, in a real-world setting. Methods: This prospective, observational study across 11 countries included participants with T2DM treated with Gla-300 in pre-Ramadan, Ramadan and post-Ramadan periods. The primary endpoint was the percentage of participants experiencing !1 event of severe and/or symptomatic documented hypoglycaemia with self-monitored plasma glucose (SMPG) 70 mg/dL during Ramadan. Secondary endpoints included change in HbA 1c and insulin dose and adverse events (AEs). Results: The mean ± SD number of fasting days was 30.1 ± 3.2. The percentage of participants experiencing !1 event of severe and/or symptomatic documented hypoglycaemia (SMPG 70 [<54] mg/dL) was low in the pre-Ramadan (2.2% [0.8%]), Ramadan (2.6% [0%]) and post-Ramadan (0.2% [0%]) periods. No participants reported severe hypoglycaemia during Ramadan or post-Ramadan; one participant reported severe hypoglycaemia in pre-Ramadan. HbA 1c fell pre-to post-Ramadan, and Gla-300 daily dose (mean ± SD) was reduced pre-Ramadan to Ramadan (from 25.6 ± 11.9 U/0.32 ± 0.14 U/kg to 24.4 ± 11.5 U/0.30 ± 0.13 U/kg). Incidence of AEs was 5.5%. Conclusions: In ORION, people with T2DM treated with Gla-300 who fasted during Ramadan had a low risk of severe/symptomatic hypoglycaemia and improved glycaemic control.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Real-world safety and effectiveness of insulin glargine 300 U/mL in participants with type 2 diabetes who fast during Ramadan: The observational ORION study

Hassanein

Büyükbeşe²,

Malek

et al. 2020

Diabetes Research and Clinical Practice

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“…At this point in time, clinical guidelines for transitioning patients safely in and out of Ramadan are generally lacking. There are, however, some intensive resources for therapeutic guidance on caring for diabetic patients produced by the Diabetes and Ramadan International Alliance (DaR) and other collaborators such as Diabetes Canada [45]. Those guidelines can be used along with RAMCOM when training clinicians to assist them in the care process.…”

Section: Discussionmentioning

confidence: 99%

RAMCOM: A qualitative study of clinicians’ viewpoints on a tool for communication with Muslim patients considering fasting during Ramadan

Amin

Abdelmageed

2020

PLoS ONE

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Fasting during the month of Ramadan is a basic pillar of Islam. While patients may be religiously exempted from fasting, literature indicates that the majority decide to fast. Caring for millions of Muslim patients who decide to fast during Ramadan can be challenging for clinicians around the globe. This study proposes a communication tool, RAMCOM, which aims to assist clinicians in communicating with Muslim patients considering fasting during Ramadan. It addresses the following questions: What are the clinicians' preferences for the tool in terms of Content, Format, Style, Length and language? How do clinicians perceive factors that would impact their intentions to sue the tool? What would facilitate the implementation and dissemination of the proposed tool? Methods Semi-structured interviews were conducted with a purposeful sample of clinicians in Egypt (11) and the US (10). Clinicians were purposefully sampled to assure variance in age, gender, time in practice, specialty, and religious background. Directed content analysis was conducted and emerging data were mapped to constructs within the theory of planned behavior. Iterative sampling and analysis continued until saturation was reached. Results In total, 21 clinicians were interviewed. The tool was iteratively revised according to clinicians' comments on format, content, language and usability. Factors contributing to using RAMCOM included perception of tool (need for use, perceived burden of use), perceived norm (perceived patient expectations), and ability to use tool (time, frequency of seeing patients, knowledge of Ramadan and Islam). Practice environment factors that impact the use of RAMCOM include education, early reminders, colored laminated copies, communication training, involvement of support staff, and patient education.

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“…8 Most research concerning diabetes and fasting during Ramadan originates from Muslim countries; however, due to sociodemographic and geographical differences, different countries have developed their own guidelines for diabetes patients who intend to fast during Ramadan. 10 Diabetes self-management behaviors are necessary to ensure optimum glycemic control during Ramadan. A number of sociodemographic factors might affect the knowledge, attitude and practice with regard to Ramadan in patients with type 2 diabetes.…”

Section: Introductionmentioning

confidence: 99%

<p>Knowledge, Attitude and Practice Regarding Ramadan Fasting and Related Determinants in Patients with Type 2 Diabetes at a Saudi Diabetes Clinic</p>

Alsunni

Albaker

Almansour

et al. 2020

DMSO

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This study was carried out in type 2 diabetes mellitus (T2DM) patients to assess their knowledge, attitude and practice about fasting during Ramadan and to identify the sociodemographic determinants of the knowledge, attitude and practice. Methods: A total of 107 T2DM patients were interviewed at a diabetes clinic in the Eastern Saudi Arabia. A questionnaire containing knowledge, attitude and practice questions about fasting during Ramadan was used to collect data. Data about age, gender, city of residence, nationality, level of education, and history of diabetes in family were also collected. Descriptive and inferential statistics were carried out using IBM-SPSS Version 21. Results: The mean total score for knowledge, attitude and practice was 16.5 ±3.72 (out of 27). The individual scores for knowledge, attitude and practice were: 9.67±2.53 (out of 16), 4.10±1.28 (out of 6), and 2.77±1.08 (out of 5), respectively. Gender (OR: 4.08, 95% CI: 1.05,15.79 and p<0.041), education (OR: 0.068, 95% CI: 0.008,0.594, p<0.015) and family history (OR: 5.086, 95% CI: 1.095, 23.630 p<0.038) were identified as independent determinants of the total score. Conclusion: Gender, Family history of diabetes and Education are determinants of knowledge, attitude and practice regarding fasting during Ramadan in the T2DM patients. A significant knowledge practice gap exists that necessitates further strengthening of the Pre-Ramadan education program for T2DM patients.

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Diabetes Canada Position Statement for People With Types 1 and 2 Diabetes Who Fast During Ramadan

Cited by 34 publications

References 42 publications

Real-world safety and effectiveness of insulin glargine 300 U/mL in participants with type 2 diabetes who fast during Ramadan: The observational ORION study

Real-world safety and effectiveness of insulin glargine 300 U/mL in participants with type 2 diabetes who fast during Ramadan: The observational ORION study

RAMCOM: A qualitative study of clinicians’ viewpoints on a tool for communication with Muslim patients considering fasting during Ramadan

<p>Knowledge, Attitude and Practice Regarding Ramadan Fasting and Related Determinants in Patients with Type 2 Diabetes at a Saudi Diabetes Clinic</p>

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