Diversity in endocrinology practice: the case of Ramadan

Ilias, Ιoannis; Tayeh, Luai Said; Pachoundakis, Isidoras

doi:10.14310/horm.2002.1630

Cited by 1 publication

(1 citation statement)

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“…Without clear guidance from the field, many physicians are led astray while managing this vulnerable cohort. Also, without a clear scientific voice, religious guidance suffers; rendering patients who wish to fulfil their religious obligations vulnerable to complications (10,11,12,13). A couple of review articles attempted to offer guidance on the management of AI during Ramadan.…”

Section: Introductionmentioning

confidence: 99%

Management of adrenal insufficiency during Ramadan fasting: a survey of physicians

Beshyah

Ali

Saadi

2020

Endocrine Connections

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Introduction: Appropriate dose adjustments of glucocorticoids replacement therapy for adrenal insufficiency (AI) is vital. Objective: We sought to scope physicians’ perceptions, and practices regarding Ramadan fasting (RF) impact on the management of AI. Methods: A web-based survey of a convenience sample of endocrinologists. Results: Nearly two-thirds of 145 respondents (64.1%) were adult endocrinologists and almost half (49%) saw more than 10 hypoadrenal patients per year. Most respondents (78.6%) prescribed hydrocortisone, while the minority prescribed other preparations. The glucocorticoid doses were reportedly divided twice daily by 70.8% and thrice daily by 22.2% of respondents. Respondents recognized RF as having potential consequences in adrenal insufficiency patients included causing hypoglycaemia, undue tiredness, and fatigue, hypotension, feeling dizzy, and light-headedness. Symptoms of under-replacement were thought to happen in the late afternoon by 59.3% of respondents. Almost half (45.5%) of respondents thought that RF has some probable or definite impact on glucocorticoid therapy that certainly warrants specific concern and possible action. Three quarters (76.4%) of respondents confirmed providing specific management recommendations during RF. The most frequently reported recommendation was taking in the usual morning dose of hydrocortisone just before pre-dawn meal (Suhor) (57.8%). A third switch patients from hydrocortisone to prednisolone/prednisone. Half reported providing patients with specific recommendations regarding breaking their fast and/or seeking help if hypoadrenal symptoms occur. Conclusions: There is a remarkable variation in the physicians’ perceptions and practices regarding the management of AI during Ramadan. This warrants professional effort to increase the awareness and dissemination of evidence-based guidelines.

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Section: Introductionmentioning

confidence: 99%