The DAR 2020 Global survey: Ramadan fasting during COVID 19 pandemic and the impact of older age on fasting among adults with Type 2 diabetes

Hassanein, Mohamed; Hussein, Zanariah; Shaltout, Inass; Seman, Wan Juani Wan; Tong, Chin Voon; Noor, Nurain Mohd; Büyükbeşe, Mehmet Akif; Tony, Lobna El; Shaker, Gamal Mohamed; Alamoudi, Reem; Hafidh, Khadija; Fariduddin, M; Batais, Mohammed Ali; Shaikh, Shehla; Malek, Pr Rachid; Alabbood, Majid; Sahay, Rakesh; Alshenqete, Abdulwadod M.; Ahmedani, Muhammad Yakoob

doi:10.1016/j.diabres.2021.108674

Cited by 31 publications

(37 citation statements)

References 13 publications

(42 reference statements)

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“…Ramadan fasting is a religious obligation for healthy Muslim adults [1]. Although the Quran exempts certain individuals from fasting [2], such as those who are ill, many Muslims with diabetes choose to participate in Ramadan fasting [3][4][5][6][7][8][9]. Studies confirmed that approximately 43%-80% of people with type 1 diabetes (T1D) [3,8,9] and 79%-95% of people with type 2 diabetes (T2D) fasted at least 15 days during Ramadan [3][4][5][6]; according to these studies, they fasted an average of 23-27 and 27 days, respectively.…”

Section: Introductionmentioning

confidence: 99%

“I am my own doctor”: A qualitative study of the perspectives and decision-making process of Muslims with diabetes on Ramadan fasting

Bouchareb

Chrifou²,

Bourik³

et al. 2022

PLoS ONE

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Background Many Muslims with diabetes choose to fast against medical advice during Ramadan, potentially increasing their risk of acute complications. Patients are often reluctant to disclose fasting to their health care providers, and their needs regarding Ramadan are not met in consultations. For healthcare professionals to provide patient-centred care, it is important to gain more insight into patients’ decision-making process. This study therefore aims to explore how Muslims with diabetes decide whether to fast during Ramadan. Methods A qualitative study was conducted consisting of 15 focus groups with Muslims with diabetes within a constructivist paradigm. Convenience sampling was used. All focus groups were transcribed verbatim and analyzed using Braun and Clarke’s reflexive thematic analysis. Results Four themes were found to be important in the decision on whether to fast: (1) values and beliefs concerning Ramadan, (2) experiences and emotions concerning Ramadan, (3) the perception of illness, and (4) advice from health care professionals, imams and family. Many participants indicated fasting against medical advice and trusting their subjective assessments on whether they could fast. Moreover, three main stages in the decision-making process for eventually refraining from fasting were identified: (1) the stage where positive experiences with fasting dominate, (2) the stage where one encounters challenges but their determination to fast prevails and (3) the stage where one decides to refrain from fasting after experiencing too many physical difficulties with fasting. Conclusions Muslims with diabetes experience autonomy in their decisions on Ramadan fasting. The decision to refrain from fasting often resulted from a difficult and dynamic decision-making process and was often made after participants reached their physical limits. These findings highlight the importance of not only shared decision-making to empower patients to make well-informed decisions on Ramadan fasting but also pre-Ramadan diabetes education to help people with diabetes have a safe Ramadan.

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Section: Introductionmentioning

confidence: 99%

“I am my own doctor”: A qualitative study of the perspectives and decision-making process of Muslims with diabetes on Ramadan fasting

Bouchareb

Chrifou²,

Bourik³

et al. 2022

PLoS ONE

Self Cite

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show abstract

“…However, studies during Ramadan in the Middle East, including those on patients with diabetes for instance ( 21 , 22 ) and our own experience in Emirati individuals with T1DM and T2DM in a prospective study has shown that at least 80% of these choose to fast most of Ramadan (unpublished data). Hence, extrapolating from Diabetes and Research alliance ( 16 ) surveys conducted in high-risk patients, it will be safe to assume that patients with thyroid disorders are even more likely to fast during Ramadan.…”

Section: Discussionmentioning

confidence: 94%

Ramadan Fasting and Changes in Thyroid Function in Hypothyroidism: Identifying Patients at Risk

Alkaf

Siddiqui

Ali

et al. 2022

Thyroid

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Background: Ramadan fasting (RF) is associated with major changes in meal times. This can affect thyroxine absorption and thyroid function (TF) in patients with hypothyroidism. We aimed to examine the short- and long-term impact of RF on TF in patients with primary hypothyroidism on levothyroxine. Methods: TF tests in patients with primary hypothyroidism attending an endocrine center in the United Arab Emirates were retrospectively analyzed. The impact of RF on TF, namely serum thyrotropin (TSH) TSH, free thyroxine (fT4) and free triiodothyronine (fT3), was investigated in 481 patients within 3 months before Ramadan (BR), 1–2 weeks (PR1), and 3–6 months (PR2) post-Ramadan. Controlled TF was defined as TSH between 0.45 and 4.5 μIU/mL. Inadequate control was defined as TSH >4.5 μIU/mL. Loss of control was defined as having controlled TF at BR and inadequate control at PR1. Multivariable regression analyses were used to assess the association of baseline TSH, baseline levothyroxine dose, and medication use with loss of thyroid control in Ramadan. Results: TSH increased significantly from a median of 2.0 (0.8–3.7) μIU/mL at BR to 2.9 (1.4–5.6) μIU/mL at PR1 ( p < 0.001). This was accompanied by a fall in fT4 and fT3 at PR1 ( p < 0.001). 25.5% of patients with previously controlled TF at BR had deterioration in TF at PR1. Sixty-one percent of patients with previously uncontrolled TF at BR remained uncontrolled at PR1. Baseline TSH was significantly associated with loss of thyroid control in Ramadan with an odds ratio (95% confidence interval) of 1.5 (1.17–1.92) ( p < 0.001), whereas other variables, including medications known to affect levothyroxine absorption were not associated with loss of control. TSH, fT4, and fT3 levels returned to normal at PR2. Conclusions: RF can negatively affect TF of patients on levothyroxine replacement. Although this effect is modest and transitory in most patients, a significant minority exhibit more pronounced, and clinically relevant changes. The latter includes those with higher TSH BR, and a smaller group whose thyroid disease appears to be particularly affected by the mealtime and lifestyle changes of Ramadan.

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“…It is thus rational that those with a higher baseline fCal will be the most prone to clinical deterioration when an inciting factor (fasting) is present. Older patients are more prone to negative effects of fasting such as dehydration and hypoglycaemia, the symptoms of which might raise the “physician global assessment” part of the partial Mayo score [ 54 ]. Elderly patients also more commonly have comorbidities and have polypharmacy problems that are compounded during the month of Ramadan.…”

Section: Discussionmentioning

confidence: 99%

Effect of Ramadan intermittent fasting on inflammatory markers, disease severity, depression, and quality of life in patients with inflammatory bowel diseases: A prospective cohort study

et al. 2022

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Background Intermittent fasting (IF) during the month of Ramadan is part of the religious rituals of Muslims. The effect of intermittent fasting on disease activity in inflammatory bowel diseases (IBD) is still unknown. This is the first study to assess the effect of IF during Ramadan on inflammatory markers in patients diagnosed with IBD. The effects on clinical disease activity, quality of life, and levels of depression were also assessed. Methods Patients diagnosed with ulcerative colitis (UC) or Crohn’s disease (CD) who intended to observe Ramadan fasting were recruited. The following were assessed immediately before and at the end of Ramadan: Serum CRP and stool calprotectin, partial Mayo score, Harvey Bradshaw index (HBI), Simple IBD questionnaire (SIBDQ), and Hamilton depression scale questionnaire. Results 80 patients diagnosed with IBD were recruited (60 UC, 20 CD). Serum CRP and stool calprotectin did not show a significant change before vs after fasting (median CRP 0.53 vs 0.50, P value = 0.27, Calprotectin 163 vs 218 respectively, P value = 0.62). The partial Mayo score showed a significant rise after fasting (median 1 before vs 1 after fasting, mean: 1.79 vs 2.33 respectively, P value = 0.02). Harvey-Bradshaw index did not show a significant change after fasting (median 4 vs 5, P value = 0.4). Multiple linear regression revealed that older age and a higher baseline calprotectin were associated with a higher change in Mayo score after fasting (P value = 0.02 and P value = 0.01, respectively). No significant change was detected in SIBDQ or Hamilton depression scale scores. Conclusions In patients diagnosed with UC, IF during Ramadan was associated with worsening of clinical parameters, the effect was more pronounced in older patients and those with higher baseline calprotectin levels. However, IF during Ramadan was not associated with an adverse effect on objective inflammatory markers (CRP and calprotectin).

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The DAR 2020 Global survey: Ramadan fasting during COVID 19 pandemic and the impact of older age on fasting among adults with Type 2 diabetes

Cited by 31 publications

References 13 publications

“I am my own doctor”: A qualitative study of the perspectives and decision-making process of Muslims with diabetes on Ramadan fasting

“I am my own doctor”: A qualitative study of the perspectives and decision-making process of Muslims with diabetes on Ramadan fasting

Ramadan Fasting and Changes in Thyroid Function in Hypothyroidism: Identifying Patients at Risk

Effect of Ramadan intermittent fasting on inflammatory markers, disease severity, depression, and quality of life in patients with inflammatory bowel diseases: A prospective cohort study

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