Fasting, Diabetes, and Optimizing Health Outcomes for Ramadan Observers: A Literature Review

Abstract

IntroductionGlobally, and in Australia, diabetes has become a common chronic health condition. Diabetes is also quite prevalent in culturally and linguistically diverse pockets of the Australian population, including Muslims. There are over 90 million Muslims with diabetes worldwide. Diabetes management and medication use can be affected by religious practices such as fasting during Ramadan. During Ramadan, Muslims refrain from oral or intravenous substances from sunrise to sunset. This may lead to many potential health or medication-related risks for patients with diabetes who observe this religious practice. This literature review aimed to explore (1) health care-related interventions and (2) intentions, perspectives, or needs of health care professionals (HCPs) to provide clinical services to patients with diabetes while fasting during Ramadan with a view to improve health outcomes for those patients.MethodsUsing a scoping review approach, a comprehensive search was conducted. Databases searched systematically included PubMed, Medline, Embase, and International Pharmaceutical Abstracts. Studies published in English that described interventions or intentions to provide interventions regarding diabetes and Ramadan fasting were included.ResultsFourteen published articles that met the inclusion criteria were retrieved and content analyzed. Of those, nine intervention studies regarded diabetes management education. Five studies described professional service intention, four of which were related to the role of pharmacists in diabetes management in Qatar, Australia, and Egypt, and one French study examined the general practitioners’ (GPs) experiences in diabetes management for Ramadan observers. The intervention studies had promising outcomes for diabetes management during Ramadan. Effect sizes for improvement in HbA1c post intervention ranged widely from −1.14 to 1.7. Pharmacists appeared to be willing to participate in programs to help fasting patients with diabetes achieve a safe therapeutic outcome. Service intention studies highlighted pharmacists’ and GPs’ need for training prior to providing services from a clinical as well as cultural competence perspective.ConclusionInterventions research in this area requires robustly designed and structured interventions that can be tested in different contexts. This literature review revealed many gaps regarding diabetes management in Ramadan. Health professionals are willing to provide services for fasting diabetes patients, but need upskilling.

Efficacy and Safety of Use of the Fasting Algorithm for Singaporeans With Type 2 Diabetes (FAST) During Ramadan: A Prospective, Multicenter, Randomized Controlled Trial

“…29 The positive effects of empowerment with the FAST tool on glycemic control were mirrored by a systematic review of Ramadan-specific education interventions, in which improvements in HbA 1c level were observed (effect size range: -1.14% to +1.70% [-12.5 to +18.6 mmol/mol]). 9 The present study also provided evidence for health care clinicians to incorporate cul- turally tailored modifications in the glucose-lowering regimen during Ramadan. 5,18 The universal uptake of modifications in glucose-lowering regimen with the use of the FAST tool maintained good glycemic control for individuals with type 2 diabetes.…”

“…8 In addition, the practice of Ramadan fasting increases the risks of complications of acute diabetes, such as hypoglycemia, hyperglycemia with or without ketoacidosis, dehydration, and thrombosis, in poorly managed patients. 5,9 Thus, fasting during Ramadan entails abrupt shifts in meal timing and physical activities, which affect circadian rhythmicity and lifestyle behaviors. 5,7,8 Although Islamic law exempts the sick from fasting, Ramadan fasting remains a deeply rooted sociocultural practice that provides spiritual enhancement and social cohesion among observant Muslims with type 2 diabetes, with up to 94.2% reported to fast for at least 15 days during Ramadan.…”

Fasting in Ramadan with type 1 diabetes: A dose adjustment for normal eating workshop in Kuwait

“…It is also essential for individuals with diabetes to be able to effectively manage their blood glucose and avoid severe hypoglycaemia and hyperglycaemia episodes and ultimately DKA. Previous studies have demonstrated the effectiveness of Ramadan-specific education in type 2 diabetes (Almansour, Chaar, & Saini, 2017). Optimum diabetes management can be achieved through pre-Ramadan education and dose adjustments for both type 1 and type 2 diabetes (Hassanein et al, 2019).…”

The effect of Ramadan fasting on cardiovascular events and risk factors in patients with type 2 diabetes: A systematic review

“…Most of the available guidelines for people with diabetes planning to fast on Ramadan are based on expert opinions. However, there is a lack of scientific evidence on the safety of fasting in people with diabetes [4,5].…”