Recommendations for management of diabetes during Ramadan: update 2015

Abstract

Since the first ADA working group report on the recommendations for management of diabetes during Ramadan in 2005 and our update in 2010, we received many inquiries asking for regular updates on information regarding education, nutritional habits and new oral and injectable agents that may be useful for the management of patients with diabetes during Ramadan. Patients can be stratified into their risk of hypoglycemia and/or complications prior to the start of the fasting period of Ramadan. Those at high risk of hypoglycemia and with multiple diabetic complications should be advised against prolonged fasting. Even in the lower hypoglycemia risk group, adverse effects may still occur. In order to minimize adverse side effects during fasting in patients with diabetes and improve or maintain glucose control, education and discussion of glucose monitoring and treatment regimens should occur several weeks prior to Ramadan. Agents such as metformin, thiazolidinediones and dipeptidyl peptidase-4 inhibitors appear to be safe and do not need dose adjustment. Most sulfonylureas may not be used safely during Ramadan except with extreme caution; besides, older agents, such as chlorpropamide or glyburide, should not be used. Reduction of the dosage of sulfonylurea is needed depending on the degree of control prior to fasting. Misconceptions and local habits should be addressed and dealt with in any educational intervention and therapeutic planning with patients with diabetes. In this regard, efforts are still needed for controlled prospective studies in the field of efficacy and safety of the different interventions during the Ramadan Fast.

Initial increase in glucose variability during Ramadan fasting in non-insulin-treated patients with diabetes type 2 using continuous glucose monitoring

“…Subjects were asked to report any symptomatic or serious hypoglycaemic events defined as hypoglycaemia associated with severe cognitive impairment requiring external assistance for recovery [7] during CGM recording days or fast breaking during Ramadan month. Education and advice about adjustment of anti-diabetic treatment and doses for the Ramadan period were given to all subjects before Ramadan started according to clinical guidelines [8]. …”

Comparative studies of dipeptidyl peptidase 4 inhibitor vs sulphonylurea among Muslim Type 2 diabetes patients who fast in the month of Ramadan: A systematic review and meta-analysis

“…The use of DPP4 inhibitor has been shown to have similar glycemic efficacy compared to insulin secretagogue in the general population, with an extra advantage of lower hypoglycemic risk [22][23][24]. DPP4 inhibitors are also considered safer during Ramadan with no major dose adjustment needed [25]. Risk of hypoglycemia is increased during Ramadan because of daytime fasting.…”

Knowledge of diabetes mellitus and safe practices during Ramadan fasting among Muslim patients with diabetes mellitus in Singapore

“…(10,14) Studies have shown that interventional education programmes, such as those used in the Ramadan Education and Awareness in Diabetes study and the Ramadan Prospective Diabetes Study, (15,16) were able to reduce the high complication rates that were observed during fasting (as demonstrated in the EPIDIAR study (3) ). Other studies have also shown that there is a need for preparation (e.g.…”