Risk of diabetic ketoacidosis during Ramadan fasting: A critical reappraisal

Beshyah, Salem A; Chowdhury, Tahseen A; Ghouri, Nazim; Lakhdar, A.

doi:10.1016/j.diabres.2019.02.027

Cited by 32 publications

(27 citation statements)

References 33 publications

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“…Earlier publications, not supported by evidence, suggested an increased risk of DKA during Ramadan. Beshyah and colleagues evaluated the validity of the perceived increased risk and the actual occurrence of DKA during fasting in Ramadan in a non-systematic, narrative review of literature and found that the risk of DKA was not increased during fasting [81]. Consequently, these authors de-emphasized the earlier proposed risk of DKA during Ramadan, creating a more balanced approach for those wishing to fast during Ramadan.…”

Section: Hyperglycaemia and Ketoacidosismentioning

confidence: 99%

Ramadan and Diabetes: A Narrative Review and Practice Update

et al. 2020

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Fasting in the Islamic month of Ramadan is obligatory for all sane, healthy adult Muslims. The length of the day varies significantly in temperate regions-typically lasting C 18 h during peak summer in the UK. The synodic nature of the Islamic calendar means that Ramadan migrates across all four seasons over an approximately 33-year cycle. Despite valid exemptions, there is an intense desire to fast during this month, even among those who are considered to be at high risk, including many individuals with diabetes mellitus. In this review we explore the current scientific and clinical evidence on fasting in patients with diabetes mellitus, focussing on type 2 diabetes mellitus and type 1 diabetes mellitus, with brief reviews on pregnancy, pancreatic diabetes, bariatric surgery, the elderly population and current practice guidelines. We also make recommendations on the management of diabetes patients during the month of Ramadan.

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Section: Hyperglycaemia and Ketoacidosismentioning

confidence: 99%

Ramadan and Diabetes: A Narrative Review and Practice Update

et al. 2020

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“…Approximately 90 million Muslims are living with diabetes [3]. Studies reported that Ramadan fasting had no adverse effects on healthy people [12,13], but it could lead to wide blood glucose fluctuations and increase the risks of acute metabolic complications, such as hypoglycemia, hyperglycemia, diabetic ketoacidosis, dehydration, and thrombosis, in the population with diabetes [2,3,14]. More seriously, two studies [3,15] showed that it was more difficult and riskier for people with T1DM to manage their medical condition during Ramadan even under optimal Ramadan-specific education.…”

Section: Introductionmentioning

confidence: 99%

Experiences and views of people with diabetes during Ramadan fasting: A qualitative meta-synthesis

Liao

Wang

et al. 2020

PLoS ONE

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Objectives To review and appraise the existing qualitative studies on Ramadan fasting in participants with diabetes and to integrate valuable qualitative evidence for optimizing diabetes management. Methods Twelve databases (PubMed, Embase, Cochrane Library, Science Direct, CINAHL, PsycINFO, JBI (Joanna Briggs institute), Web of Science, and four Chinese databases) were searched to identify qualitative studies on experiences and perspectives of Ramadan fasting in participants with diabetes. CASP (Critical Appraisal Skills Program) Qualitative Checklists were applied to appraise the included studies. A meta-synthesis approach was used to analyze the included studies. Through the strategy of inductive thematic synthesis and reciprocal interpretation, the findings and quotations of the included studies were integrated into new themes and categories. The CERQual (Confidence in the Evidence from Reviews of Qualitative Research) tool was used to grade the confidence of the new themes. Results A total of 11 qualitative studies were included, and 43 findings were isolated. Ten new themes were identified and synthesized from the findings. Finally, four new categories were integrated, including the knowledge and understanding of observing Ramadan fasting, well-being and challenges, self-efficacy, and needs and expectations of participants with diabetes during Ramadan. Conclusions Insulin-dependent individuals call for special concern during Ramadan fasting. Ramadan-focused education needs to be developed and generalized, and existing guidelines should be improved to optimize the management of diabetes. Professional HCPs contribute to weigh the health risks and mental satisfaction for their patients, partly, to balance health and religion. Participants’ psychological construction is another concern for religious scholars and psychologists.

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“…Further study with a larger sample is needed to prove this. [17] Acute complications were recorded most frequently in the 1 st week of fasting in Ramadan, namely 50.88% (29/57), of which 62% (18/29) were hyperglycemia. This may be because the patient is still adapting to changes in meal times, and the increased consumption of high-carbohydrate foods at iftar and dawn, accompanied by changes in physical activity.…”

Section: Discussionmentioning

confidence: 92%

“…By classifying based on risk complication initially, patients can get medical advice that it would be more safety for them not to fast if there is a high-risk of complications during fasting, and if they still decide to fast, the patient already knows the types of complications risk and how big the chances of complications are that can happen to them, and able to take steps to prevent complications, and tighter supervision during fasting by themselves, the people around them and the doctors who treat them. [17] There are many factors that can affect the incidence of acute complications during Ramadan fasting, one of which is type of antihyperglycemia drug. To determine the correlation between the type of therapy and the incidence of acute complications in DM patients undergoing Ramadan fasting, Kruskal Wallis categorical comparative analysis was used with a value of p = 0.731.…”

Section: Discussionmentioning

confidence: 99%

Correlation between Risk Stratification of Complications and Types of Antihyperglycemia Drugs with Incidence of Acute Diabetic Complications in Patients with Diabetes Mellitus during Ramadan Fasting

Sasiarini¹,

Simatupang²,

Arsana³

2020

CRJIM

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Ramadan fasting for Diabetes Mellitus (DM) patients can lead to acute complications such as hypoglycemia, hyperglycemia, diabetic ketoacidosis (DKA) and thrombosis. Risk stratification predicts fasting safety of DM patients. Dose and timing of antihyperglycemia drugs adjusted during Ramadan fasting. Aim: To know the correlation between the risk stratification of Ramadan fasting and type of antihyperglycemia drugs with the incidence of acute complications in DM patients undergoing Ramadan fasting. Methods: DM patients in Endocrinology Clinic, dr. Saiful Anwar, General Hospital Malang who intend to fast during Ramadan classified in IDF-DAR risk stratification, conduct blood glucose monitoring and filled out a daily logbook during fasting. Results: Thirty-seven subjects were included in the study, only 1 patient with type-1 DM. Average fasting time is 18 days. Acute complications found higher in very high-risk group (5/6) compared to mild/moderate (2/13) and high-risk group (7/18) (p=0.009). Acute complications found higher in group with OAD and insulin combination regiment (2/4) compared to OAD (9/24) or insulin group (3/9) (p= 0. 731). One subject in very high-risk group suffered from acute coronary syndrome. Relationship between risk stratification and the incidence of hypoglycemia (p=0.040) and hyperglycemia (p=0.031) was significant. Relative risk in the very high-risk group was 2.538 compared to mild/moderate risk RR (95% CI)= 0.77 (0.62-0.96). Conclusions: There is a correlations between risk stratification and acute complications in DM patients undergoing Ramadan fasting. No relationship between type of antihyperglycemia drugs with acute complications of Ramadan fasting.

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Risk of diabetic ketoacidosis during Ramadan fasting: A critical reappraisal

Cited by 32 publications

References 33 publications

Ramadan and Diabetes: A Narrative Review and Practice Update

Ramadan and Diabetes: A Narrative Review and Practice Update

Experiences and views of people with diabetes during Ramadan fasting: A qualitative meta-synthesis

Correlation between Risk Stratification of Complications and Types of Antihyperglycemia Drugs with Incidence of Acute Diabetic Complications in Patients with Diabetes Mellitus during Ramadan Fasting

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