Compliance with Medical Advice and Safety in High-Risk Diabetis Patients During Ramadan
DOI:
https://doi.org/10.37762/jgmds.13-3.863Keywords:
Diabetes Mellitus, Fasting, Hypoglycemia, Hyperglycemia, IDF-DAR guidelines, Ramadan, High-Risk Patients, Patients Compliance, Patient SafetyAbstract
ABSTRACT
OBJECTIVES
This study was designed to evaluate compliance with medical recommendations and safety outcomes among high-risk diabetic patients during Ramadan in Peshawar, Pakistan.
METHODOLOGY
This descriptive study encompassed 246 high-risk diabetic patients (type 2 DM, risk score >6, aged 40-75 years) at Khyber Teaching Hospital, observed over six months, including Ramadan. Data were gathered via structured questionnaires, baseline and follow-up evaluations, and telephone interviews conducted after Ramadan. Compliance was assessed based on adherence to medical recommendations. The complications were compared between groups that followed the rules and those that did not. SPSS version 27 was used for statistical analysis.
RESULTS
A total of 246 individuals participated in the study, with a mean age, HbA1c, and average weight of 56.17 years, 9.4%, and 63 kg. 44.7% of the individuals who took part attempted to fast during Ramadan. Only 16.2% of individuals fasted for all 30 days, and 55.3% of individuals did not fast at all. Overall, 35.4% of individuals reported having hypoglycemia, with 68.1% of fasting individuals having at least one episode compared to 8.8% of the non-fasting group (p < 0.001). Patients who were fasting experienced more hyperglycemia and dehydration (p < 0.001). Regular self-monitoring of blood glucose was not very satisfactory, with only 31.7% of people following the recommended steps. Of 221 high-risk diabetic patients, the majority had type 2 diabetes and were on insulin therapy; however, only one-third frequently monitored their blood glucose levels.
CONCLUSION
Despite medical advice, many high-risk individuals with diabetes continue to observe fasting during Ramadan. This renders them more likely to develop hypoglycemia, hyperglycemia, and dehydration. For this highly susceptible population to be safer, it is important to improve patient education, offer tailored counseling, and follow risk-based guidelines.
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Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: global, regional, and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. doi:10.1016/j.diabres.2021.109119. PMID: 34879977 DOI: https://doi.org/10.1016/j.diabres.2021.109119
International Diabetes Federation Guideline Development Group. Global guideline for type 2 diabetes. Diabetes Res Clin Pract. 2014;104(1):1-52. doi:10.1016/j.diabres.2012.10.001 DOI: https://doi.org/10.1016/j.diabres.2012.10.001
Al-Arouj M, Assaad-Khalil S, Buse J, Fahdil I, Fahmy M, Hafez S, et al. Recommendations for management of diabetes during Ramadan: update 2010. Diabetes Care. 2010;33(8):1895-902. doi:10.2337/dc10-0896. PMID: 20668156 DOI: https://doi.org/10.2337/dc10-0896
Hassanein M, Afandi B, Ahmedani MY, Alamoudi RM, Alawadi F, Bajaj HS, et al. Diabetes and Ramadan: practical guidelines 2021. Diabetes Res Clin Pract. 2022;185:109185. doi:10.1016/j.diabres.2021.109185. PMID: 34896243 DOI: https://doi.org/10.1016/j.diabres.2021.109185
Salti I, Bénard E, Detournay B, Bianchi-Biscay M, Le Brigand C, Voinet C, et al. A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the EPIDIAR study. Diabetes Care. 2004;27(10):2306-11. doi:10.2337/diacare.27.10.2306. PMID: 15451892 DOI: https://doi.org/10.2337/diacare.27.10.2306
Elbarsha A, Elhemri M, Elmehdawi R. Comparison between high- and low-risk diabetic patients who fast Ramadan: a prospective cohort study. Ibnosina J Med Biomed Sci. 2020;12(3):208-214. doi:10.4103/ijmbs.ijmbs_48_20 DOI: https://doi.org/10.4103/ijmbs.ijmbs_2_20
International Diabetes Federation, Diabetes and Ramadan International Alliance. IDF-DAR Practical Guidelines: Diabetes and Ramadan. Brussels: International Diabetes Federation; 2016
American Diabetes Association. Glycemic targets: Standards of Care in Diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S98-S110. doi:10.2337/dc24-S006 DOI: https://doi.org/10.2337/dc24-S006
Jehangir F, Khan T, Aziz Z, Giani A, Adnan T. Fasting in Ramadan is safe for individuals suffering from type 2 diabetes mellitus in Pakistan. Pak J Med Dent. 2020;9(3):25-31 DOI: https://doi.org/10.36283/PJMD9-3/006
Malik SE, Kanwal S, Haider I, Javed J, Iqbal Y, Bibi S. Comprehension of long-term medications in patients with type 2 diabetes mellitus: a KAP study. J Gandhara Med Dent Sci. 2024;11(2):23-27. doi:10.37762/jgmds.11-2.533 DOI: https://doi.org/10.37762/jgmds.11-2.535
Malik SE, Kanwal S, Javed J, Naeem H, Jehandad Z, Haider I. Association of level of education and occupation with diabetic foot ulcer in patients with type 2 diabetes mellitus. J Med Sci. 2023;31(4):295-300 DOI: https://doi.org/10.52764/jms.23.31.4.8
Babineaux SM, Toaima D, Boye KS, Zagar A, Tahbaz A, Jabbar A, Hassanein M. Multi-country retrospective observational study of the management and outcomes of patients with type 2 diabetes during Ramadan in 2010 (CREED). Diabet Med. 2015;32(6):819-828. doi:10.1111/dme.12647. PMID: 25345585 DOI: https://doi.org/10.1111/dme.12685
Noon MJ, Khawaja HA, Ishtiaq O, Khawaja Q, Minhas S, Niazi AK, et al. Fasting with diabetes: a prospective observational study. BMJ Glob Health. 2016;1(2):e000009. doi:10.1136/bmjgh-2015-000009 DOI: https://doi.org/10.1136/bmjgh-2015-000009
Jabbar A, Hassanein M, Beshyah SA, Boye KS, Yu M, Babineaux SM. Hypoglycaemia during Ramadan in individuals with type 2 diabetes mellitus: the CREED study. Diabetes Res Clin Pract. 2017;132:19-26. doi:10.1016/j.diabres.2017.07.005. PMID: 28734782 DOI: https://doi.org/10.1016/j.diabres.2017.07.014
Hassanein M, Al-Arouj M, Hamdy O, Bebakar WMW, Jabbar A, Al-Madani A, et al. Diabetes and Ramadan: practical guidelines. BMJ Open Diabetes Res Care. 2019;7(1):e000603. doi:10.1136/bmjdrc-2018-000603. PMID: 30687574
Hassanein M, Ahmedani MY, Shaltout I, Alabbood M, Buyukbese MA, Hafidh K, et al. Ramadan fasting among adults with type 2 diabetes in five geographically different regions of the world: the DAR 2020 Global Survey. Diabetes Epidemiol Manag. 2024;16:100229. doi:10.1016/j.deman.2024.100229 DOI: https://doi.org/10.1016/j.deman.2024.100229
Al Reesi A, Al Reesi H, Al Ghaithi S, Al Ali I, Al Siyabi S, Al Balushi S, et al. Impact of the IDF-DAR risk stratification and pre-Ramadan education on diabetes-related complications. J Diabetes Endocr Pract. 2025;8(3):179-185. doi:10.1055/s-0045-1809656 DOI: https://doi.org/10.1055/s-0045-1809385
Al Awadi FF, Echtay A, Al Arouj M, Ali SS, Shehadeh N, Al Shaikh A, et al. Patterns of diabetes care among people with type 1 diabetes during Ramadan: an international prospective study (DAR-MENA T1DM). Adv Ther. 2020;37(4):1550-1563. doi:10.1007/s12325-020-01279-3. PMID: 32144670 DOI: https://doi.org/10.1007/s12325-020-01267-4
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