Mini-symposium: Ramadan fasting and the medical patient: An overview for clinicians

Beshyah, Salem A; Fathalla, Waseem; Saleh, Abdulkarim; Al-Kaddour, Abdulrazzak; Noshi, Mohamed; Hatheethi, Husni Al; Al-Saadawi, Nameer; Elsiesy, Hussien; Amir, Numan; Almarzouqi, Mohamed; Khalil, Ali B; Benbarka, Mohamed M; Ahmed, Urooj; Mustafa, Huda Ezzedin; Almahmeed, Wael

doi:10.4103/1947-489x.211004

Cited by 32 publications

(34 citation statements)

References 33 publications

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“…12 Others noted that under medical supervision fasting was possible for most patients with stable cardiovascular disease without any significant harmful effects. 13,14 Another systemic review and metanalysis revealed that the incidence of cardiac events during fasting was found to be similar to the non-fasting period and Ramadan fast was not related to any increase in the incidence of acute cardiac disease. 15 Similarly, study reported that fasting has no effect on stroke occurrence 16 as well as on number of hospitalization needed for people with cerebrovascular accidents.…”

Section: Discussionmentioning

confidence: 99%

The frequency of major complications among fasting people with diabetes according to risk categories of IDF-DAR guidelines 2016

Iqbal

Askari

Ahmedani

2020

Clinical Epidemiology and Global Health

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Aim/background: To determine the frequency of major complications among fasting people with diabetes according to risk categories of IDF-DAR guidelines 2016. Methods: This prospective observational study was conducted around Ramadan of 2017, at Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan. People with diabetes having intention to fast during Ramadan were recruited. Demographic data collection along with risk categorization was done during pre-Ramadan visit. Structured education was given on one to one basis to each of the study participants. Assessment of complications was made during post Ramadan visit. Results: There were 131 participants in this study. Mean age was 53.77 ± 12.67 years. Sixty three percent were males. 4.58% were of type 1 diabetes while 95.41 were of type 2 diabetes. Mean duration of diabetes was 9.92 ± 7.752 years and mean HbA1c was 8.711 ± 1.878. Major hypoglycemia occurred in 31.2% of very highrisk category only. None of the high risk and moderate/low risk categories had major hypoglycemia. There was no major hyperglycemia noted in any of the categories of patients. 50% of very high risk and 3.3% of high-risk category required breaking of fast. None of the participants required hospitalization. Conclusion: In this prospective study, majority of fasting people with diabetes fall into high risk category and did not develop major complications. Very high-risk category had highest number of complications while low to moderate category develop none. Further large-scale studies are needed to validate our finding.

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Section: Discussionmentioning

confidence: 99%

The frequency of major complications among fasting people with diabetes according to risk categories of IDF-DAR guidelines 2016

Iqbal

Askari

Ahmedani

2020

Clinical Epidemiology and Global Health

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“…Interest in the medical aspects of fasting has increased in the last 30 years [11,12]. In particular, studies on the management of patients with diabetes mellitus have been focused, but the studies focusing on the medical management of thyroid diseases in relation to Ramadan fasting are limited [7,13].…”

Section: Introductionmentioning

confidence: 99%

Should the dose of levothyroxine be changed in hypothyroidism patients fasting during Ramadan?

Koca¹,

Dağdeviren²,

Altay³

2020

Turk J Med Sci

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Background/aim: Muslims worship by fasting from predawn (suhoor) until sunset (iftar) for 30 days in the religious month of Ramadan. In addition to prolonged hunger, patients fasting with a diagnosis of hypothyroidism take their doses of levothyroxine (LT4) outside of daytime fasting hours. The purpose of our study is to compare the values of hypothyroid patients which have been obtained through thyroid function tests before and after Ramadan.Materials and methods: Ninety-seven patients; ranging from 18 to 65 years old, who were followed with a diagnosis of hypothyroidism, who fasted during Ramadan, and who had no change of their LT4 dose for at least 6 months were included in the study. Results:The median serum thyroid-stimulating hormone (TSH) level of patients prior to fasting was 2.19 mIU/L, while median serum TSH after fasting was 2.73 mIU/L. Serum TSH values after Ramadan increased significantly compared to those prior to Ramadan (P = 0.004). Conclusion:Our study demonstrates a significant increase in serum TSH levels after Ramadan but no significant change in serum free thyroxine (fT4) levels in hypothyroidism patients who are fasting. It may be appropriate to take precautions by making a small increase in LT4 dose before Ramadan in some hypothyroid patients wishing to fast.

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“…Management of a number of chronic medical conditions in Ramadan has been addressed by Beshyah et al . ( 4 ). In endocrinology, the management of diabetes mellitus has attracted the most attention with the largest volume of literature ( 5 ).…”

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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Mini-symposium: Ramadan fasting and the medical patient: An overview for clinicians

Cited by 32 publications

References 33 publications

The frequency of major complications among fasting people with diabetes according to risk categories of IDF-DAR guidelines 2016

The frequency of major complications among fasting people with diabetes according to risk categories of IDF-DAR guidelines 2016

Should the dose of levothyroxine be changed in hypothyroidism patients fasting during Ramadan?

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

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