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.
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ABSTRACT: Objectives
The DAR Global surveyof Ramadan-fasting during the COVID-19 pandemic aimed to describe the characteristics and care in participants with type 2 diabetes (T2D)with a specific comparison between those < 65years and>65 years.Methods
Participantswere consented to answer aphysician-administered questionnairefollowing Ramadan 2020. Impact of COVID-19 on the decision of fasting,intentions to fast and duration of Ramadan and Shawalfasting, hypoglycaemia and hyperglycaemia eventswere assessed. Specific analysis comparing age categories of <65 years and>65years were performed.Results
Among the 5865 participants, 22.5% were>65 years old. Concern for COVID-19 affected fasting decisionfor 7.6% (> 65years) vs 5.4% (<65years). More participants >65 years old did not fast (28.8% vs 12.7%,<65 years). Of the 83.6%, participantsfulfillingRamadan-fasting, 94.8%fasted >15 days and 12.6% had to break fast due to diabetes-related illness.The average number of days fasting within and post-Ramadan were 27 and 6 days respectively, regardless of age. Hypoglycaemia and hyperglycaemia occurred in 15.7% and 16.3% of participants respectively,with 6.5% and 7.4% requiringhospital care respectively. SMBGwas performed in 73.8% of participants and 43.5% received Ramadan-focused education.Conclusion
During the COVID-19 pandemic, universally high rates of Ramadan-fasting were observedregardless of fasting risk level.Glycemic complications occurred frequently witholder adults requiring higher rates of acute hospital care. Risk stratification is essential followed bypre-Ramadan interventions, Ramadan-focused diabetes education and self-monitoringto reduce and prevent complications, with particular emphasis in older adults.
SUBMITTER: Hassanein M
PROVIDER: S-EPMC7826018 | BioStudies | 2021-01-01
REPOSITORIES: biostudies
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Project description:<h4>Objectives</h4>The DaR Global survey was conducted to determine the impact of the COVID-19 pandemic on the intentions to fast and the outcomes of fasting in <18 years versus ?18 years age groups with type 1 diabetes mellitus (T1DM).<h4>Methods</h4>Muslim people with T1DM were surveyed in 13 countries between June and August 2020, shortly after the end of Ramadan (23rd April-23rd May 2020) using a simple questionnaire.<h4>Results</h4>71.1% of muslims with T1DM fasted during Ramadan. Concerns about COVID-19 were higher in individuals ?18 years (p = 0.002). The number of participants who decided not to fast plus those who received Ramadan-focused education were significantly higher in the ?18-year group (p < 0.05). Hypoglycemia (60.7%) as well as hyperglycemia (44.8%) was major complications of fasting during Ramadan in both groups irrespective of age.<h4>Conclusion</h4>COVID-19 pandemic had minor impact on the decision to fast Ramadan in T1DM cohort. This was higher in the age group of ?18 years compared to those <18 years group. Only regional differences were noted for fasting attitude and behavior among T1DM groups. This survey highlights the need for Ramadan focused diabetes education to improve glucose control and prevent complications during fasting.
2020-01-01 | S-EPMC7836519 | BioStudies
Project description:There is a large population of people with type 2 diabetes mellitus (T2DM) who are Muslim and fast during Ramadan. Changes in the pattern and amount of meal and fluid intake during Ramadan, in addition to the long fasting hours, may increase the risk of hypoglycaemia, hyperglycaemia, and dehydration. The Canagliflozin in Ramadan Tolerance Observational Study (CRATOS) evaluated the tolerability of canagliflozin, a sodium glucose co-transporter 2 inhibitor, compared with sulphonylureas among patients with T2DM who fast during Ramadan.This non-randomised, parallel-cohort, prospective, comparative, observational study was conducted in the Middle East during Ramadan and enrolled patients who were taking canagliflozin (n=162) or any sulphonylurea (n=159) added to metformin±dipeptidyl peptidase-4 inhibitor. The proportion of patients who experienced hypoglycaemia events was assessed as the primary end-point. Between-cohort comparisons were adjusted using propensity score analysis.During Ramadan, fewer patients experienced symptomatic hypoglycaemia with canagliflozin vs sulphonylurea (adjusted odds ratio: 0.273 [95% CI: 0.104, 0.719]). Of hypoglycaemia events for which blood glucose was measured, two of six with canagliflozin and 27 of 37 with sulphonylurea were confirmed by blood glucose <3.9 mmol/L. More patients treated with canagliflozin experienced volume depletion events compared with sulphonylurea (adjusted odds ratio: 3.5 [95% CI: 1.3, 9.2]). Missed fasting days were few and medication adherence was high in both groups. No patients treated with canagliflozin and 9.4% treated with sulphonylurea adjusted their medication dose near the beginning of Ramadan. Both treatments were generally well tolerated, with low rates of adverse events and no serious adverse events in either group.Overall, these findings support the use of canagliflozin for the treatment of adults with T2DM who fast during Ramadan. CLINICALTRIALS.NCT02737657.
2017-01-01 | S-EPMC5656913 | BioStudies
Project description:We determined the impact of a remote blood glucose telemonitoring program with feedback in type 2 diabetes mellitus patients fasting during Ramadan compared to conventional self-monitoring method. A twelve-week cluster randomised study, with 85 participants who wish to fast for at least 15 days during Ramadan was conducted. Self-measurement and transmission of blood glucose results were performed six times daily during Ramadan. Results were transmitted to a secure website for review with feedback from case manager if necessary. The control group received usual care. The main outcome was the number of participants experiencing hypoglycaemia during Ramadan and at the end of the study. During Ramadan, the number of participants reporting hypoglycaemia was significantly lower in the telemonitoring group [Odds ratio (OR): 0.186, 95% confidence interval: 0.04-0.936; p?=?0.04]. Similarly, the proportion of participants reporting symptomatic hypoglycaemia at the end of the study was significantly lower in the telemonitoring group (OR: 0.257, 95% CI: 0.07-0.89; p?=?0.03). A reduction of 1.07% in glycated haemoglobin levels was observed in the telemonitoring group compared to 0.24% in the control group (p?<?0.01). Overall, telemonitoring was a useful adjunct to reduce the risk of hypoglycaemia during Ramadan with no deterioration in glycaemic control.
2017-01-01 | S-EPMC5579057 | BioStudies
Project description:<h4>Objective</h4>To assess the incidence of hypoglycemia in people with type-2 diabetes mellitus (T2DM) on three or more anti-diabetic medications during Ramadan.<h4>Study design methods</h4>We have studied people with T2DM on three or more glucose-lowering drugs during Ramadan of H1438 (May-June 2017). The dose of each drug was adjusted according to a pre-specified protocol. The incidence of symptomatic or blood glucose confirmed hypoglycemia was recorded during the study.<h4>Results</h4>We enrolled 228 people with T2DM; 181 completed the study, and data on hypoglycaemia was available in 172 subjects. There were 115 males and 66 females, (mean age?±?SD) 53.6?±?9.7 years, diabetes duration 10?±?6 yrs. The incidence of hypoglycaemia was 16.3% (28/172). Univariable logistic regression analysis showed that the risk of hypoglycaemia was increased in Arab subjects compared to Qatari; in those with longer duration of diabetes; and in those on four or more anti-diabetic medications compared to those on three anti-diabetic medications.<h4>Conclusion</h4>Despite the tailored advice, there is a high incidence of hypoglycemia in people with T2DM taking multiple glucose lowering therapies whilst fasting during Ramadan. Guidelines should address the increased complexity in anti-diabetic medications in patients who fast during Ramadan. Healthcare providers should individualize the modifications in anti-diabetic medications during Ramadan.
2018-01-01 | S-EPMC6405393 | BioStudies
Project description:<h4>Background</h4>Recently, electronic cigarette (e-cig) usage has increased significantly, making it a potentially effective smoking cessation tool. In Muslim countries, most people who use e-cigarettes fast the month of Ramadan, which results in intermittent fasting. This study aims to reveal the severity of e-cig withdrawal symptoms among users during this intermittent fasting period.<h4>Methods</h4>A self-administered survey was developed and validated to solicit anonymous responses from e-cig users living in Jordan, through a cross-sectional study design. Participants were recruited through social media resources. Severity scores of physical (out of 11) and psychological (out of 8) withdrawal symptoms for each participant were assessed and calculated for each participant, depending on the symptoms reported.<h4>Results</h4>A convenience sample (n?=?523) of e-cig adult users were recruited. The majority of the participants were males (96.4%) aged between 18 and 40 years (86.4%). Many participants replaced tobacco smoking with e-cig (53.5%) in order to help them stop smoking. More than half of the participants experienced relatively weak physical (0.82?±?1.78) and psychological (1.24?±?1.89) withdrawal symptoms during the month of fasting. Most of the participants (63.2%) preferred to engage themselves with a busy schedule to tolerate the related withdrawal symptoms they experienced.<h4>Conclusion</h4>E-cigs could play a vital role in smoking cessation among tobacco smokers during intermittent fasting. Ramadan offers a good opportunity for smokers to quit, as the reported physical and psychological e-cig withdrawal symptoms were found to be relatively weak. Awareness and behavioral interventions would help clarify the effect of e-cigs and help determine alternative ways to cease smoking.
2021-01-01 | S-EPMC7864140 | BioStudies
Project description:<h4>Background</h4>During the fasting month of Ramadan, practicing Saudis develop severe disturbances in sleeping and feeding patterns. Concomitantly, cortisol circadian rhythm is abolished, diurnal cortisol levels are elevated and circulating levels of several adipokines are altered favouring insulin resistance.<h4>Aim</h4>To examine changes in the expression of CLOCK and glucocorticoid-controlled genes, such as DUSP1 and IL-1? in Saudi adults before and during Ramadan, and to investigate possible associations with selected cardiometabolic risk factors.<h4>Methods</h4>Healthy young volunteers (5 females, 18 males; mean age +SEM = 23.2 +1.2 years) were evaluated before Ramadan and two weeks into it. Blood samples were collected at 9 am (±1 hour) and twelve hours later for determination of serum lipid profile, high sensitivity CRP (hsCRP), and adiponectin. The expression of CLOCK, DUSP1 and IL-1? was evaluated in circulating leukocytes.<h4>Results</h4>Mean levels of GGT and morning adiponectin decreased, while those of LDL-c/ HDL-c and atherogenic index (AI) increased significantly in Ramadan compared to Shabaan. There was no significant difference between morning and evening adiponectin during Ramadan, while the diurnal rhythm of hsCRP was lost. CLOCK gene expression mean was significantly higher in morning than in evening during Shabaan. Mean morning and evening DUSP1 mRNA levels showed significant increase during Ramadan compared to Shabaan, however, its diurnal rhythm was maintained. Morning IL-1? mRNA expression remained significantly higher than in the evening during Ramadan, but was markedly decreased compared to Shabaan.<h4>Discussion</h4>Ramadan fasting in Saudi Arabia is associated with improvements in some cardiometabolic risk factors, such as circulating GGT and hsCRP and leukocyte expression of IL-1? mRNA, suggesting that intermittent fasting might have a beneficial component. These benefits may be offset by the previously reported dysregulation in the circadian rhythm, excess glucocorticoid levels and action, and insulin resistance, explaining increased prevalence of cardiometabolic disorders and type 2 diabetes mellitus.
2017-01-01 | S-EPMC5401765 | BioStudies
Project description:<h4>Objective</h4>To describe maternal and neonatal glycaemic control following antenatal corticosteroid administration to women with diabetes in pregnancy.<h4>Design</h4>Retrospective cohort study.<h4>Setting</h4>A tertiary hospital in Auckland, New Zealand.<h4>Population</h4>Women with diabetes in pregnancy who received antenatal corticosteroids from 2006-2016.<h4>Methods</h4>Corticosteroid administration, maternal and neonatal glycaemia data were retrieved from electronic patient records. Demographic data were downloaded from the hospital database. Relationships between variables were analysed using multivariate analysis.<h4>Main outcome measures</h4>Maternal hyperglycaemia and neonatal hypoglycaemia.<h4>Results</h4>Corticosteroids were administered to 647 of 7317 of women with diabetes (8.8%) who gave birth to 715 babies. After an initial course of corticosteroids, 92% and 52% of women had blood glucose concentrations > 7 and > 10 mmol/L respectively. Median peak blood glucose concentration of approximately 10 mmol/L occurred 9 hours after corticosteroid administration and hyperglycaemia lasted approximately 72 hours. Thirty percent of women gave birth within 72 hours of the last dose of corticosteroids. Babies of women who were hyperglycaemic within 24 hours of birth were more likely to develop hypoglycaemia (< 2.6 mmol/L, OR 1.51 [95% CI 1.10-2.07], p = 0.01) and severe hypoglycaemia (? 2.0 mmol/L, OR 2.00 [95% CI 1.41-2.85], p < 0.0001) than babies of non-hyperglycaemic mothers. There was no association between maternal glycaemia within 7 days of the last dose of corticosteroids and neonatal hypoglycaemia.<h4>Conclusions</h4>Hyperglycaemia is common in women with diabetes in pregnancy following antenatal corticosteroid administration. Maternal hyperglycaemia in the 24 hours prior to birth is associated with increased risk of neonatal hypoglycaemia. Limitations included the retrospective study design, so that not all data were available for all women and babies and the glucose testing schedule was variable.
2021-01-01 | S-EPMC7891747 | BioStudies
Project description:BACKGROUND:Ramadan fasting is compulsory for all healthy adult Muslims. Although sick people are exempted from Ramadan fasting, some patients such as hemodialysis patients prefer to fast during Ramadan. The effect of Ramadan fasting on clinical outcomes and biochemical markers among hemodialysis patients is not clear. The aim of this study was to examine the effects of daily Ramadan fasting and partial Ramadan fasting on key biochemical and clinical markers among hemodialysis patients as compared to hemodialysis patients who chose not to fast during Ramadan. METHODS:A prospective cohort study of 269 end stage renal disease patients were recruited from the hemodialysis unit in An-Najah National University Hospital, Nablus, Palestine. The participants were divided into three cohorts based on their plans for fasting during Ramadan in May 2018; Ramadan fasting group (RFG), Ramadan partial fasting group (RPFG) and Ramadan not-fasting group (RNFG). Key clinical and biochemical markers were measured before, during and after Ramadan. RESULTS:After adjustment for diabetic and hypertension status and other sociodemographic variables, RFG had higher mean inter-dialytic weight gain (IDWG) by 0.62 kg than RNFG (95% confidence interval (CI) 0.26, 0.99). RPFG also had slight increase in mean IDWG than RNFG by 0.35 kg (95% CI 0.11, 0.60). Additionally, RFG and RPFG had significant increase in mean serum potassium as compared to RNFG. Diabetes was independently associated with increased IDWG by 0.48 kg (0.25, 0.72). Diabetes and hypertension were associated with some independent changes in biochemical markers, but these were clinically negligible. CONCLUSION:Our findings suggest that Ramadan fasting (fully or partially) is tolerable by hemodialysis patients and is not associated with important clinical complications. However, these patients should be made aware of the potential risk of fluid overload and hyperkalemia, if they decide to fast during Ramadan. Thus, they should be closely monitored and instructed to adhere to their dietary and fluid intake allowances. Further prospective cohort studies with comprehensive dietary measures and information on adverse clinical outcomes may provide more evidence about the tolerability and safety of Ramadan fasting by hemodialysis patients.
2019-01-01 | S-EPMC6590819 | BioStudies
Project description:INTRODUCTION:To describe the characteristics and care of participants with type 1 diabetes during Ramadan in the Middle East and North Africa. METHODS:The DAR-MENA (Diabetes and Ramadan-Middle East and North Africa) study was a prospective, observational study of adults with type 1 and type 2 diabetes who were Muslim and did/did not intend to fast during Ramadan 2016. Baseline data were collected 6 weeks prior to Ramadan, with a follow-up visit 1-2 months after Ramadan. This is the analysis of the population with type 1 diabetes. Measurements included proportion who fasted, reasons for fasting and not fasting, changes in diabetes treatment, hypoglycemic events, and proportion with access to diabetes education. RESULTS:Of 136 participants with type 1 diabetes, 76.9% (100/130) fasted for at least 1 day, 72.3% (94/130) fasted for at least 15 days, and 48.5% (63/130) fasted for 30 days. The majority (63.0%, 63/100) reported personal decision as a reason to fast. Fear of diabetic complications (58.6%, 17/29) and previous complications related to fasting (48.3%, 14/29) were the most common reasons for not fasting. Adjustment of diabetic medication regimen occurred for 84.6% (115/136) of participants, and 72.8% (99/136) changed their treatment dose. The incidence and number of adverse events for confirmed and severe hypoglycemia were similar before and during Ramadan. Almost half of participants had access to diabetes education (45.6%, 62/136). CONCLUSION:The DAR-MENA study showed that despite the risks associated with fasting for people with type 1 diabetes, almost half fasted for the full 30 days of Ramadan with no significant change in hypoglycemia events. Since the current International Diabetes Federation and Diabetes and Ramadan guidelines do not endorse fasting for people with type 1 diabetes, it is important that those who insist on fasting work closely with their healthcare practitioner to avoid any complications.
2020-01-01 | S-EPMC7140750 | BioStudies
Project description: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???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. Many patients admit to a do-it-yourself approach to diabetes mellitus management during Ramadan, largely due to an under-appreciation of the risks and implications of the rigors of fasting on their health. Part of the issue may also lie with a healthcare professional's perceived inability to grasp the religious sensitivities of Muslims in relation to disease management. Thus, the pre-Ramadan assessment is crucial to ensure a safe Ramadan experience. Diabetes patients can be risk-stratified from low, medium to high or very high risk during the pre-Ramadan assessment and counselled accordingly. Those who are assessed to be at high to very high risk are advised not to fast. The current COVID-19 pandemic upgrades those in the high-risk category to very high risk; hence a significant number of diabetes patients may fall under the penumbra of the 'not to fast' advisory. We recognize that fasting is a personal choice and if a person chooses to fast despite advice to the contrary, he/she should be adequately supported and monitored closely during Ramadan and for a brief period thereafter. Current advancements in insulin delivery and glucose monitoring technologies are useful adjuncts to strategies for supporting type 1 diabetes patients considered to be high risk as well as 'high-risk' type 2 patients manage their diabetes during Ramadan. Although there is a lack of formal trial data, there is sufficient evidence across the different classes of therapeutic hypoglycaemic agents in terms of safety and efficacy to enable informed decision-making and provide a breadth of therapeutic options for the patient and the healthcare professional, even if the professional advice is to abstain. Thus, Ramadan provides an excellent opportunity for patient engagement to discuss important aspects of management, to improve control in the short term during Ramadan and to help the observants understand that the metabolic gains achieved during Ramadan are also sustainable in the other months of the year by maintaining a dietary and behavioural discipline. The application of this understanding can potentially prevent long-term complications.
2020-01-01 | S-EPMC7480213 | BioStudies