Patient perspectives on type 2 diabetes and medicine use during Ramadan among Pakistanis in Denmark

Mygind, Anna; Kristiansen, Maria; Wittrup, Inge; Nørgaard, Lotte Stig

doi:10.1007/s11096-012-9716-1

Cited by 40 publications

(60 citation statements)

References 16 publications

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Section: Discussionmentioning

confidence: 99%

“…Additionally, fasting has been associated with a feeling of improvement in overall well-being, having a positive impact on social, cultural, and religious domains [28]. Health care professionals are seldom included in the spiritual decision as to whether or not a patient chooses to fast during Ramadan [27, 28]. The recent study by Gaborit and colleagues in France showed that many GPs had limited medical knowledge of Ramadan fasting in patients with diabetes, leading to over half of them proscribing fasting, even when it was not medically justified.…”

Section: Discussionmentioning

confidence: 99%

“…This wide gap between GPs’ and patients’ attitudes highlights the lack of training and subsequent difficulties in such cross-cultural patient-physician relationships [27]. However, structured educational programs, such as the Ramadan Education and Awareness in Diabetes (READ) program, have clearly shown positive effects [28], in particular in minimizing the risk of hypoglycemia [29, 30]. This Ramadan-focused diabetes education needs to involve not just the health care team but also the patients’ families, friends, community, and religious authorities.…”

Section: Discussionmentioning

confidence: 99%

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Experience with Vildagliptin in Type 2 Diabetic Patients Fasting During Ramadan in France: Insights from the VERDI Study

et al. 2013

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AimTo assess in real life the rate of hypoglycemia during Ramadan in patients with type 2 diabetes (T2DM) in France, according to their ongoing dual therapy of metformin-vildagliptin or metformin-sulfonylurea/glinide (IS).MethodsProspective, non-interventional study with 2 visits (within 8 weeks before and 6 weeks after the end of Ramadan 2012). Study diaries were not used to collect events or record values of glucose monitoring. One hundred and ninety-eight patients on stable oral dual therapy for ≥2 months and with glycosylated hemoglobin (HbA1c) ≤8.0% were recruited by 62 centers: 83 in the IS cohort and 115 in the vildagliptin cohort.ResultsApproximately 90% of patients were from Maghreb. The two cohorts were well balanced: 60% men, mean age 59 years, BMI 28 kg/m2, metformin dose ~2,000 mg/day, and HbA1c 7.2%. Distinct therapeutic management was planned in view of Ramadan with drug-adaptation intended in 61.4% of IS and 18.3% of vildagliptin patients. Hypoglycemia was reported in 37% of IS and 34% of vildagliptin patients; episodes declared as confirmed in 30.8% and 23.5%, respectively, and episodes documented as adverse event (AE) in 17.9% (22 episodes) and 7.5% (13 episodes), respectively (P = 0.025). Severe episodes were reported in 3.9% of IS and 1.7% of vildagliptin patients. 10.4% of IS and 2.6% of vildagliptin patients reported severe episodes and/or unscheduled medical visits due to hypoglycemia (P = 0.029). Glycemic control remained stable in both cohorts. Compliance with fasting was high, as well as adherence to drug with ≥5 missed-dose for 15.4% of IS and 8.5% of vildagliptin patients.ConclusionAlthough the overall frequency of malaise suggestive of hypoglycemia was high, which would be expected with prolonged fasting in a well-controlled T2DM population during hot summer days, the incidence of more severe and better-documented episodes (AE, severe event, event leading to unscheduled medical visit) were much lower, with consistently less events with vildagliptin therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Experience with Vildagliptin in Type 2 Diabetic Patients Fasting During Ramadan in France: Insights from the VERDI Study

et al. 2013

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“…Culturally insensitive recommendations were ineffective, in that, directing patients peremptorily not to fast did not appear to deflect vulnerable patients from still undertaking the fast [42]. Generally, patients may choose to ignore HCP advice, especially if they feel the HCP is not culturally attuned to their decisions [42, 46, 47]. In the case of Ramadan fasting, where religious beliefs strongly motivate patients to fast, HCPs (physicians and pharmacists) and religious sources, such as imams (Muslim religious priests), may need to collaborate as important sources of knowledge about fasting and medication use for patients.…”

Section: Discussionmentioning

confidence: 99%

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

2017

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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.

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“…However, Danish studies among ethnic minorities have identified a high prevalence of medication-related problems in such patients, and also found that these problems could be identified, assessed and solved in collaboration between the patient, the community pharmacy and the general practitioner [14,15].…”

Section: Introductionmentioning

confidence: 99%

Safe and Effective Use of Medicines for Ethnic Minorities - A Pharmacist- Delivered Counseling Program That Improves Adherence

Herborg¹

2015

J Pharma Care Health Sys

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Background: From studies, we know how ethnic minorities and people with reduced work ability often suffer from health problems, thus being socially disadvantaged. The municipal job centers are confronted with numerous problems related to medicine use and they lack relevant means of referral. Thus, there was a need to adapt a previously developed and validated medicine-based intervention "safe and effective use of medicines" to this vulnerable group of unemployed ethnic minority patients. Methods:The objective of this before-after study was to improve medicines adherence, health status and work ability of the target group through an individualized pharmacist delivered intervention with focus on safe and effective implementation of medical treatments. The target group was ethnic minorities of non-western origin affiliated with a job center.Results: At baseline, 35.7 % of the patients had a potential adherence behavior problem Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation (having an average adherence score of less than 5); at endpoint, this number had decreased to 27.3 %, meaning that 8.4 % no longer had potential adherence problems. Self-reported adherence was significantly improved on three out of four subscales ("Intentional, selfregulation" from 4.5 to 4.7, p=0.016); "Unintentional" from 3.9 to 4.2, p=0.009); "Intentional, effect-related" from 4.0 to 4.4, p=0.025; "General" 4.3 to 4.5, p=0.173.). On average, 47 % of the patients experienced improvements in concordance, due to the intervention. Conclusion:The counseling program "Safe and effective use of medicines" was successfully adapted to unemployed ethnic minority patients, and tested in a new collaboration between job centers and community pharmacies. The counseling program resulted in statistically significant improvements in self-reported adherence as well as improved concordance for approximately half of the patients. Improvements in adherence removes one barrier for returning to the work force that exists in the complex interaction between adherence, health status and work ability. Citation: Dam P, El-Souri M, Herborg H, Nørgaard LS, Rossing C, et al. (2015) Safe and Effective Use of Medicines for Ethnic Minorities -A

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Patient perspectives on type 2 diabetes and medicine use during Ramadan among Pakistanis in Denmark

Cited by 40 publications

References 16 publications

Experience with Vildagliptin in Type 2 Diabetic Patients Fasting During Ramadan in France: Insights from the VERDI Study

Experience with Vildagliptin in Type 2 Diabetic Patients Fasting During Ramadan in France: Insights from the VERDI Study

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

Safe and Effective Use of Medicines for Ethnic Minorities - A Pharmacist- Delivered Counseling Program That Improves Adherence

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