Fasting during the month of ramadan for people with diabetes: Medicine and fiqh united at last

Abstract

Fasting during the lunar month of Ramadan is a religious obligation for all adult Moslems. Under certain circumstances, afewgroupsareexemptfromfastingsuchasbeing"sick" asjudgedbyanexperienceddoctor.Recentcollaboration between the International Islamic FiqhAcademy and The Islamic Organization for Medical Sciences produced a comprehensive guidance based on extensive review of the evidence of possible risk to diabetic patients if they observefasting.Thenewguidancecategorizedpeoplewith diabetesinto4groupsaccordingtotheirrisk.Group1and 2areexemptedfromfastingastheyhaveriskfromfasting. Theseincludedpatientswithpoorglycemiccontrolorwith complicationsandseriouscoexistingillnessesinadditionto type1patientsandpregnantwomenwithdiabetes.Patients in groups 3 and 4 are those with moderate to low risk of harmfromfasting.Theseareexemplifiedbyuncomplicated patientswithstablecontrolonoraldrugsnotassociatedwith excessriskofhypoglycemia.Thesegroupsofpatientshave no harm but may even benefit from fasting. Doctors and religious scholars have a joint responsibility to properly assess and advise patients to choose to fast or not to fast inlinewiththeserecommendations.Theadviceshouldbe givenwith no complacencywith the potentialhealth risks butwithgreatsensitivitytothepatientsreligiousfeelings.

Diabetes patient management by pharmacists during Ramadan

“…Fortunately, diabetes management strategies during Ramadan have been proposed by international medical and religious bodies [1,6-9]. General considerations include pre-Ramadan medical assessment and patient education regarding meal planning; physical activity; the need for increased frequency of blood glucose monitoring and the recognition and management of acute complications.…”

Diabetes and Ramadan: Practical guidelines

“…Taking all these risks into account, it is easy to see why religious regulations, as well as medical recommendations, allow exemption from fasting for some people with diabetes [8,18,19]. However, for many such individuals, fasting is a deeply spiritual experience and they will insist on taking part, perhaps unaware of the risks they are taking.…”

Effect of Ramadan Fasting on Anthropometric Measures and Metabolic Profiles among Type 2 Diabetic Subjects

“…9 Most Muslim religious authorities accept that if a person is advised by a trusted health professional that fasting is harmful to his or her health, then that person is exempted from fasting. 10 In a large observational study, patients who fasted during Ramadan without attending a structured educational session had a four-fold increase in hypoglycemic events whereas those who attended an educational program focusing on Ramadan had a significant decrease in hypoglycemic events. 11 This entails improving patient education as well as tailoring the treatment to meet the needs of this group of people with diabetes to minimize the possible risks.…”