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Ata F, Khan AA, Khamees I, Bashir M. Incidence of diabetic ketoacidosis does not differ in Ramadan compared to other months and seasons: results from a 6-year multicenter study. Curr Med Res Opin 2023; 39:1061-1067. [PMID: 37522377 DOI: 10.1080/03007995.2023.2231306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/17/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is a life-threatening adverse complication of patients with diabetes mellitus (DM). It is postulated that fasting during Ramadan can increase the risk of DKA; however, there are contradicting data in this regard. Furthermore, studies from Western countries have suggested a seasonal variation in the incidence of DKA. This study examines the differences in the number of DKA episodes during Ramadan compared to the rest of the year in patients with type 1 DM (T1D) and type 2 DM (T2D). Besides, we aim to examine the seasonal difference in the incidence of DKA. METHODS We included consecutive index-DKA admissions from 2015 to 2021 and used descriptive statistics to compare the episodes of DKA in Ramadan vs other months and seasons. RESULTS Of 922 patients, 480 (52%) had T1D, whereas 442 (48%) had T2D. The median age (IQR) was 35 (25-45) years, with the majority being Arab (N = 502, 54.4%). There were 94 DKA admissions in six collective Ramadan months, whereas the DKA admissions ranged from 61 to 88 episodes in other months (p = .3). The highest DKA admissions were observed in Autumn (N = 236) and the lowest in Spring (N = 226) with no statistically significant difference (p = .4). There were no differences in DKA severity or new-onset diabetes rates when analyzed based on Hiji months, Roman months, or seasons. CONCLUSIONS DKA occurrence is not increased during Ramadan. We found no evidence of seasonal variations in the rates of DKA in the State of Qatar.
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Affiliation(s)
- Fateen Ata
- Department of Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Adeel Ahmad Khan
- Department of Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Ibrahim Khamees
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Bashir
- Department of Endocrinology, Hamad Medical Corporation, Doha, Qatar
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Sheikh A, Das B, Sattar S, Islam N. Safety of sodium-glucose cotransporter 2 inhibitors (SGLT2i) during the month of Ramadan in patients with type 2 diabetes mellitus in Pakistani population-an observational study from a tertiary care center in Karachi. Endocrine 2023; 80:64-70. [PMID: 36580199 PMCID: PMC9798932 DOI: 10.1007/s12020-022-03290-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/19/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Primary aim was to assess the safety of SGLT2-i in patients with Type 2 Diabetes Mellitus (T2D) in a real-life scenario during Ramadan by finding the frequency and severity of hypoglycemic/hyperglycemic events, dehydration, and Diabetic ketoacidosis (DKA). Secondary aim was to assess changes in glycated hemoglobin (HbA1c), weight and creatinine levels. METHODS This prospective, observational, controlled cohort study was conducted at Aga Khan University Hospital, Karachi, Pakistan from March 15 to June 30, 2021. Participants were over 21 years of age, on stable doses of SGLT2-I, which was started at least 2 months before Ramadan. Endpoint assessments were done 1 month before and within 6 weeks after Ramadan. RESULTS Of 102 participants enrolled, 82 completed the study. Most (52%) were males, with mean age 52.2 ± 9.5 years and average duration of T2D 11.2 ± 6.5 years. 63% were on Empagliflozin (mean dose; 14.8 ± 7.2 mg/day) whereas 37% were on Dapagliflozin (mean dose; 8.2 ± 2.7 mg/day). Six (7.3%) documented symptoms of hypoglycemia. However, no episode of severe hypoglycemia, hyperglycemia, dehydration, DKA, hospitalization or discontinuation of SGLT2i was reported. HbA1c changes were (7.7 ± 1.2% from 7.9 ± 2.3%, p 0.34), weight (78.4 ± 12.9 kgs from 78.9 ± 13.3, p 0.23) and eGFR (87.8 ± 27.9 from 94.3 ± 37.6, p < 0.001). The reasons of study participants drop outs were: six did not keep any fasts; four discontinued study participation for personal reasons; three were out of city and missed post Ramadan follow-up, two protocol violation and five could not be contacted for post-Ramadan follow up during the third wave of COVID-19. CONCLUSION Results showed the safety of SGLT2i agents during Ramadan in the Pakistani population recommending it as a treatment option in adults with T2D, without any additional adverse events.
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Affiliation(s)
- Aisha Sheikh
- Section of Endocrinology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
| | | | - Saadia Sattar
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Najmul Islam
- Section of Endocrinology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Yousuf S, Ahmedani MY. Efficacy and safety of empagliflozin in people with type 2 diabetes during Ramadan fasting. Diabetes Metab Syndr 2022; 16:102633. [PMID: 36279701 DOI: 10.1016/j.dsx.2022.102633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS To explore efficacy and safety of empagliflozin in people with type2 diabetes during Ramadan fasting METHODS: People with type2 diabetes (T2DM) who were taking empagliflozin and sulphonylurea with or without a metformin and dipeptidyl peptidase inhibitors (DPP4) recruited a month before Ramadan. Glycated hemoglobin (HbA1c) and estimated glomerular filtration rate (eGFR) were recorded pre- and post-Ramadan. A predesigned diary was given to the participants to keep track of their T2DM status during Ramadan. The proportion of the people who had hypoglycaemia, or any adverse event related to the study drug was assessed after-Ramadan. RESULTS A total of 116 participants completed the study. Symptomatic episodes of hypoglycaemia were more common among people who used sulphonylurea (i.e., 8.6%). Genitourinary infections and volume depletion events were recorded more in people on empagliflozin i.e., (6.9% and 5.17%, respectively). A significant reduction in body mass index (BMI), and HbA1c was noted among people on empagliflozin post Ramadan. A significant reduction in eGFR was noted only in people who were taking empagliflozin in combination with metformin. CONCLUSION Empagliflozin was found to be safe and effective in fasting people with T2DM. Further large-scale studies are needed to validate our findings.
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Affiliation(s)
- Sanobia Yousuf
- Research Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan.
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Ahmedani MY, Basit A, Zia S, Hasan I, Masroor Q, Shaikh A, Khan J, Iqbal W. Evidence-based risk factors for major complications during Ramadan fasting in people with diabetes grouped under IDF-DAR risk categories. Diabetes Res Clin Pract 2022; 185:109234. [PMID: 35124097 DOI: 10.1016/j.diabres.2022.109234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/22/2022] [Accepted: 01/31/2022] [Indexed: 11/20/2022]
Abstract
AIM To identify evidence-based risk factors for major complications during Ramadan fasting in people with diabetes grouped under IDF-DAR risk categories. METHODS This prospective observational multicenter study was conducted by Baqai Institute of Diabetology and Endocrinology (BIDE) between April-June 2019. People with diabetes having intention to fast during Ramadan were recruited. Demographic data collection along with risk categorization was done during pre-Ramadan visit. Structured education was given on one- to-one basis to each of the study participants. Assessment of complications was done during post Ramadan visit. RESULTS A total of 1045 people with diabetes participated with near equal gender distribution. Two thirds of study population was grouped into very high- and high-risk categories. Frequencies of major hypoglycemia, major hyperglycemia, hospitalization & need to break the fast were 4.4%, 10.8%, 0.8% & 3.1% respectively. On multivariate analysis, the risk factors found for major hypoglycemia during Ramadan were male gender, use of sedatives & antidepressants & having type1 diabetes mellitus, history of DKA/HHS during last 3 months for major hyperglycemia, major hypoglycemia & hospitalization for breaking of fast while older age, acute illness, and major hypoglycemia were identified factors for hospitalization. CONCLUSION In this prospective study evidence-based risk factors for fasting related major complications were identified in people with diabetes. It is imperative to recognize these factors during pre-Ramadan risk assessment visit.
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Affiliation(s)
- Muhammad Yakoob Ahmedani
- Professor of Medicine, Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan.
| | - Abdul Basit
- Professor of Medicine, Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan.
| | - Shagufta Zia
- Family Medicine Specialist, AIMS Sugar Hospital, Peshawar, Pakistan.
| | - Imran Hasan
- Specialist Endocrinologist, Lahore General Hospital, Lahore, Pakistan
| | - Qazi Masroor
- Consultant Physician, Bahawal Victoria Hospital, Bahawalpur, Pakistan
| | - Abrar Shaikh
- Professor and Head Department of Medicine, Ghulam Mohammed Mahar Medical College Teachings Hospital, Sukkur, Pakistan
| | - Jehangir Khan
- Professor of Medicine, Abbottabad International Medical College, Abbottabad, Pakistan
| | - Waheed Iqbal
- Professor of Medicine, Mohtarma Benazir Bhutto Shaheed Medical College (MBBSMC), AJK, Pakistan
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Kumar S, Diamond T. Ramadan Fasting and Maternal and Fetal Outcomes in Pregnant Women with Diabetes Mellitus: Literature Review. Front Endocrinol (Lausanne) 2022; 13:900153. [PMID: 35813638 PMCID: PMC9263982 DOI: 10.3389/fendo.2022.900153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
There is an emerging Muslim and diabetic population in the United States and other Western countries and majority of pregnant women and patients with diabetes mellitus choose to fast during Ramadan. Fasting during Ramadan in pregnant women with diabetes may represent a 'perfect storm' of metabolic disturbances including hyperglycemia, hypoglycemia and ketosis. Recent continuous and flash glucose monitoring data suggests increased glycemic variability (fasting hypo- and post-Iftar hyperglycemia) in non-pregnant patients with diabetes during Ramadan. Only five small-scale studies, predominantly focused on women with gestational diabetes mellitus in Muslim-majority nations have explored maternal glycemic outcomes during Ramadan which is associated with lower mean blood glucose levels and higher frequency of fasting hypoglycemia. Data is limited however on important clinical outcomes such as symptomatic and serious hypoglycemia requiring hospitalization. Results have been conflicting regarding maternal Ramadan fasting and association with fetal outcomes in women without diabetes. Only one recently published study reported on perinatal outcomes in pregnant women with gestational diabetes which found no effect of Ramadan exposure on mean birthweight or macrosomia frequency but lower neonatal hypoglycemia prevalence, however a significant limitation was lack of documentation of maternal fasting status. At this stage, due to paucity of data, the current medical recommendation is against Ramadan fasting for pregnant Muslim women with diabetes. Large-scale population-based studies are warranted regarding maternal and fetal outcomes in pregnant fasting women with diabetes and such studies should characterize maternal fasting status and have meaningful and consistent clinical outcomes. High-quality data derived from these studies can assist clinicians in providing more evidence-based advice to safely navigate both mother and fetus through a potentially challenging pregnancy.
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AlZahrani AM, Zawawi MM, Almutairi NA, Alansari AY, Bargawi AA. The impact of Ramadan on visits related to diabetes emergencies at a tertiary care center. BMC Emerg Med 2021; 21:162. [PMID: 34949164 PMCID: PMC8705188 DOI: 10.1186/s12873-021-00555-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022] Open
Abstract
Background Ramadan is the ninth month of the Islamic calendar were Muslims fast from dawn until sunset. This prolonged fasting period might have an impact on patients with diabetes and their disease control. This study aimed to determine the variation in visits at the Emergency Room department (ER) during Ramadan in comparison with other lunar months at a tertiary care hospital in Jeddah city in relation to the diabetes emergencies. Methodology A retrospective cross-sectional study was conducted using electronic medical record review of patients with diabetes emergencies who visited ER of a Military hospital, from 9th to 11th lunar months during 2017–2018. Diabetes patients who visited ER and aged more than 18 years old were included. Frequency of ER visits, sociodemographic characteristics and clinical features were determined. Chi-square test, Student ‘s t-test and one-way ANOVA at p < 0.05 were used in assessing associations between variables. Results Within the selected study period, a total of 24,498 admissions were recorded in ER. The prevalence of diabetes emergencies visits was only 0.84%. Based on inclusion criteria, a total of 133 subjects were included in the study (54.1% men, 45.9% women). Majority of whom (73.7%) were on insulin therapy, and more than half of whom (51.9%) were type 2 diabetes. There was a significant difference (p = 0.001) in the prevalence of diabetes emergencies visits between the three lunar months Shaban, Ramadan and Shawal, 7, 5 and 4%, respectively. However, the highest prevalence was not in Ramadan. Despite some correlations were identified, the study found no significant differences between frequency of ER visits and various demographic, clinical factors and diabetes profile between Ramadan and other both preceding and succeeding lunar month. Conclusion In contrary with previous studies, a downward trend of prevalence, from Shaban to Ramadan, to Shawal was found. This indicated that fasting during month of Ramadan does not impact negatively on the diabetes emergencies in comparison with other months. Hyperglycemia among type 2 diabetes and insulin treated patients were recorded the highest feature of diabetes emergences visits during the three months studied with no significant differences between the months. These findings highlight the need of type 2 and insulin treated patients to be thoroughly assess by the Primary Care physicians and in-depth health education and guidance should be given to them.
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Affiliation(s)
- Abdullah M AlZahrani
- King Abdullah International Medical Research Center, Department of family medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
| | - Mawaddah M Zawawi
- Family medicine resident- fourth year, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Naif A Almutairi
- Family medicine resident- fourth year, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Ammar Y Alansari
- Emergency medicine resident- fourth year, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Amina A Bargawi
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Tong CV, Yow HY, Mohd Noor N, Hussein Z. Diabetes emergencies around Ramadan study (DEARS) - A multi-center study of diabetes emergencies admitted before, during and after Ramadan in Malaysia. Diabetes Res Clin Pract 2021; 175:108854. [PMID: 33961901 DOI: 10.1016/j.diabres.2021.108854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/30/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to determine admissions for diabetes emergencies among patients who fasted or planned to fast one month before, during and one month after Ramadan 2019 in public hospitals in Malaysia. MATERIALS AND METHODS This was a cross sectional prospective study done in 18 public hospitals in Malaysia from 7/4/2019 to 2/7/2019. Data was collected prospectively with universal sampling. All adult Muslim patients with previous diagnosis of diabetes, who were admitted for hypoglycemia, DKA or HHS were included if they had fasted and had intentions to fast. RESULTS 295 admissions for diabetes emergencies were analyzed. The pre-Ramadan period recorded the highest number of admissions (119) followed by during (106) and post-Ramadan (70). Admissions for hyperglycemic emergencies accounted for 2/3 of total admissions. 37% of admissions for hypoglycemia occurred during pre-Ramadan period compared to 32.1% during Ramadan. Contributing factors included use of sulphonylurea (59.6%), presence of nephropathy (54.5%) and past history of hypoglycemia (45.5%). Admissions for DKA were more common than HHS (119 versus 77) and highest during Ramadan period (36.1%). Most of the admissions for hyperglycemic emergencies were among those with Type 2 diabetes (75.9% for DKA and 97.4% for HHS). Only 31.5% of patients admitted for diabetes emergencies recalled having received Ramadan advice in the past. DISCUSSION Admissions for diabetes emergencies were highest during pre-Ramadan period followed by Ramadan and post-Ramadan period. This suggests that fasting during Ramadan does not increase admissions for diabetes emergencies.
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Affiliation(s)
- Chin Voon Tong
- Department of Medicine, Malacca General Hospital, Malaysia.
| | - Hui Yin Yow
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Malaysia
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Hassanein M, Abuelkheir S, Alsayyah F, Twair M, Abdelgadir E, Basheir A, Rashid F, Al Saeed M, Eltayb F, Abdellatif M, Khalifa A, Alawadi F. Evaluation of optimum diabetes care on glycemic control of patients with gestational diabetes during Ramadan fasting. Diabetes Res Clin Pract 2021; 173:108669. [PMID: 33460717 DOI: 10.1016/j.diabres.2021.108669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/22/2020] [Accepted: 01/08/2021] [Indexed: 11/22/2022]
Abstract
AIMS There is limited evidence that evaluates the impact of fasting during Ramadan in pregnant women. We explored the safety of fasting in Gestational Diabetes Mellitus (GDM) in Ramadan, while understating the glycemic variability. METHODS 25 patients with GDM who choose to fast, were enrolled and provided optimum care that included Ramadan focused education and FreeStyle LibreFlashContinuous Glucose Monitoring(FSL-CGM) was utilized for 2-4 weeks assessment period of non-Ramadan days plus 2-3 weeks during Ramadan and medication adjustment. RESULTS The average glucose improved significantly, while time in target and percent above target numerically improved during Ramadan compared to pre-Ramadan. There was significant increment on the number of hypoglycemic events in Ramadan. The average lowest blood glucose reading reduced significantly by 14 mg/dL with average duration of hypoglycemic events increased significantly by 38.5 min. CONCLUSION Our study reinforces the importance of structured education before Ramadan to deliver optimal care for the management of diabetes. Strikingly FSL-CGM demonstrated that hypoglycemia is significantly increased during Ramadan Fasting. There was effective reflection of hyperglycemic spikes, immediately post Iftar. The results corroborated with the earlier studies for higher frequency of hypoglycemia during Ramadan fasting, under similar standards of care in high-risk patients with diabetes.
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Affiliation(s)
- Mohamed Hassanein
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates.
| | - Sona Abuelkheir
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Fatima Alsayyah
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Manal Twair
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Elamin Abdelgadir
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Alaaeldin Basheir
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Fauzia Rashid
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Maryam Al Saeed
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Fawzi Eltayb
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Mohammed Abdellatif
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Azza Khalifa
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Fatheya Alawadi
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
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Gad H, Hayat T, Al-Muhannadi H, Malik BR, Mussleman P, Malik RA. Efficacy and safety of the newer oral hypoglycemic agents in patients with T2DM during Ramadan: A systematic review and meta-analysis. Diabetes Res Clin Pract 2021; 172:108562. [PMID: 33271228 DOI: 10.1016/j.diabres.2020.108562] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
AIMS This systematic review and meta-analysis aims to evaluate the safety and efficacy of the newer glucose lowering treatments on glycemic control, weight, blood pressure and hypoglycemia in patients with T2DM during Ramadan. METHODS A literature search was done in PubMed, Embase, and the Cochrane Library. Quality assessment was done using the ROBINS-I and Cochrane tools for risk of bias and analyses were performed using RevMan version 5.3. RESULTS A total of 20 studies were included in the meta-analysis. Dipeptidyl peptidase-4 inhibitors (DPP-4i) led to a significant reduction in HbA1c (%) (SMD -0.25) and a non-significant decrease in weight (kg) (SMD -1.06) during Ramadan. Glucagon-like peptide (GLP-1) agonist therapy was associated with a significant decrease in HbA1c (%) (SMD -0.68) and a non-significant decrease in weight (kg) (SMD -2.57) and systolic blood pressure (SBP) (mmHg) (SMD -3.50) after Ramadan. Sodium-glucose co-transporter 2 inhibitor (SGLT-2i) therapy was associated with a significant decrease in HbA1c (%) (SMD -0.51) and a non-significant decrease in weight (kg) (SMD -1.41), SBP (SMD -1.10) and diastolic blood pressure (DBP) (mmHg) (SMD -2.08) after Ramadan. CONCLUSIONS This systematic review and meta-analysis shows clinical benefits with the newer glucose lowering medications in patients with T2DM who fast during Ramadan.
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Affiliation(s)
- Hoda Gad
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Tabraiz Hayat
- Family Medicine, Leabaib Health Center, Primary Health Care Corporation, Doha, Qatar
| | | | - Balal Rasheed Malik
- Mobile Healthcare Service, Ambulance Department, Hamad Medical Corporation, Doha, Qatar
| | - Paul Mussleman
- Library Services, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar; Institute of Cardiovascular Medicine, University of Manchester, Manchester, United Kingdom.
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Alawadi F, Alsaeed M, Bachet F, Bashier A, Abdulla K, Abuelkheir S, Rashid F, Abdulaziz Bin Hussain A, Abdelgadir E, Alsayyah F, Elsayed M, Hassanein M. Impact of provision of optimum diabetes care on the safety of fasting in Ramadan in adult and adolescent patients with type 1 diabetes mellitus. Diabetes Res Clin Pract 2020; 169:108466. [PMID: 32971155 DOI: 10.1016/j.diabres.2020.108466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND All diabetes and Ramadan guidelines advice against fasting for people with type 1 diabetes, however, many insist on fasting. Consequently, this causes a challenge due to the risk of hypoglycaemia, hyperglycemia ± diabetic ketoacidosis. AIM To assess the impact of optimum care, which includes Ramadan-focused education, flash glucose monitoring, dietary advice and treatment adjustment on the safety of Ramadan fasting in people with type 1 diabetes. METHODS Thirty persons with type 1 diabetes who insisted to fast during Ramadan were recruited to the study. At pre-Ramadan visit, all patients received Ramadan focused education and Freestyle Libre (FSL) sensor insertion and training. Patients used the sensor for 6 weeks (pre-Ramadan and during Ramadan). The physical and biological parameters were collected 2-4 weeks before and after Ramadan. RESULTS 22 patients on basal bolus insulin and 2 on an insulin pump had FSL data. Average number of days fasted were 24. Learning benefits was reported by 95% of patients following pre-Ramadan educational session. There was no clinically significant change in physical and/or biological data between pre and post-Ramadan. 63% reported making insulin dose adjustments in Ramadan. Flash glucose monitoring data showed 46.7% of patients had more than 10 hypoglycemic episodes in the 2 weeks prior to Ramadan compared to 29.2% during Ramadan. However, none of the data were statistically significant apart from HbA1c which reduced from prior to RamadanHbA1c of 8.2% to 7.9% post Ramadan (P 0.010). There was one DKA on 2nd day of Ramadan, reported due to missing insulin dose to avoid hypoglycemia. CONCLUSION Optimal care of selective patients with type 1 diabetes with a low complication rate may allow Ramadan fasting with improvement in glycemic control and without an increase in hypoglycemia, biometric or metabolic parameters. Larger, randomized controlled trials are required to be able to generalize this as a recommendation.
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Affiliation(s)
- Fatheya Alawadi
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Maryam Alsaeed
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Fawzi Bachet
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Alaaeldin Bashier
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
| | - Khadija Abdulla
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
| | - Sona Abuelkheir
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Fauzia Rashid
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | | | - Elamin Abdelgadir
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Fatima Alsayyah
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
| | - Mohamed Elsayed
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
| | - Mohamed Hassanein
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
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Hanif W, Patel V, Ali SN, Karamat A, Saeed M, Hassanein M, Syed A, Chowdhury TA, Farooqi A, Khunti K. The South Asian Health Foundation (UK) guidelines for managing diabetes during Ramadan. Diabetes Res Clin Pract 2020; 164:108145. [PMID: 32335096 DOI: 10.1016/j.diabres.2020.108145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/04/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Fasting in the holy month of Ramadan is among the five pillars of Islam and is considered as a religious obligation by the Muslim population. People with diabetes observing the practice of fasts are at a higher risk of complications such as hypoglycaemia, hyperglycaemia and ketoacidosis due to changes in eating patterns and circadian rhythms. With the objective of mitigating these complications, the South Asian Health Foundation (UK) has developed the present guidelines based on robust evidence derived from epidemiological studies and clinical trials. METHODS We have highlighted the role of pre-Ramadan risk stratification and counselling by healthcare professionals with emphasis on the need for advice on adequate dietary and fluid intake, blood glucose monitoring and awareness of when to break the fast. RESULTS We reviewed the current literature and have given clinically-relevant recommendations on lifestyle modifications and glucose-lowering therapies such as metformin, sulphonylureas, dipeptidyl peptidase-4 inhibitors, sodium glucose co-transporter-2 inhibitors, thiazolidinediones, glucagon-like peptide-1 receptor agonists and insulin. CONCLUSIONS An individualised patient-centric treatment plan is essential to not only achieve optimal glycaemic outcomes but also enable people with diabetes to observe a risk-free month of fasting during Ramadan.
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Affiliation(s)
- W Hanif
- University Hospital Birmingham. UK.
| | | | - S N Ali
- Department of Diabetes & Endocrinology, Royal Free Hospital, London, UK
| | | | - M Saeed
- University Hospital Birmingham, UK
| | - M Hassanein
- Department of Diabetes and Endocrinology, Dubai Hospital, Dubai, United Arab Emirates
| | - A Syed
- Heartlands Hospital Birmingham, UK
| | | | | | - K Khunti
- Diabetes Research Centre, University of Leicester, UK
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Beshyah SA, Chowdhury TA, Ghouri N, Lakhdar AA. Risk of diabetic ketoacidosis during Ramadan fasting: A critical reappraisal. Diabetes Res Clin Pract 2019; 151:290-298. [PMID: 30836132 DOI: 10.1016/j.diabres.2019.02.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 02/27/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To evaluate the validity of the perceived increased risk and the actual occurrence of DKA observed during fasting in Ramadan. METHODS This is a non-systematic narrative review of the literature on the occurrence of DKA during Ramadan. Online databases (PubMed, Google Scholar, Cochrane Database, Medline OVID and CINAHL EBSCO) were searched. Three research questions are addressed 1. What is the basis of the expert opinion on the risk for DKA? 2. What is the likelihood that DKA is precipitated by Ramadan fast? and 3. What is the frequency of observed DKA during Ramadan? RESULTS The expert opinion suggesting a risk of DKA during Ramadan fasting was proposed with no evidence in the early writing on Ramadan fasting and has been reiterated and propagated since then. However, from first principles, DKA is not readily precipitated by the usual stress-free metabolic environment induced by Ramadan fasting with the exception of cases involved in the usual risk factors for metabolic decompensation. Furthermore, recent studies could not document any increase in observed DKA during Ramadan fasting in retrospective, prospective and database studies. CONCLUSIONS The current state of knowledge and evidence suggests the risk of DKA is not increased during Ramadan fasting.
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Affiliation(s)
- Salem A Beshyah
- Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Dubai Medical College, Dubai, United Arab Emirates.
| | - Tahseen A Chowdhury
- The Royal London Hospital Whitechapel, Barts Health NHS Trust, London, United Kingdom
| | - Nazim Ghouri
- Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom; Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
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Beshyah AS, Beshyah SA. The incidence of diabetic ketoacidosis during Ramadan fasting: A 10-year single-centre retrospective study. Diabetes Res Clin Pract 2019; 150:296-300. [PMID: 30685349 DOI: 10.1016/j.diabres.2019.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/28/2018] [Accepted: 01/10/2019] [Indexed: 01/08/2023]
Abstract
CONTEXT There has been an increased interest in the potential metabolic derangements and acute complications of diabetes related to the Muslims' fasting during the month of Ramadan. OBJECTIVES We compared the incidence of admissions due to diabetic ketoacidosis (DKA) during Ramadan with the admissions during other months. METHODS This is a retrospective electronic database and chart review study that included all Muslims who were admitted with DKA to Sheikh Khalifa Medical City in Abu Dhabi, United Arab Emirates. We explored the relationship of admissions to Ramadan over ten years (2005-2014). RESULTS There were 432 episodes of DKA involving 283 patients. Of these, 370 episodes (85.6%) involved 231 patients (81.6%) with type 1 diabetes. The number of admission episodes was not different during Ramadan from the average calendar month [3.6 ± 2.6 (Range 0-15) episodes/month versus 3.3 ± 2.1 (Range 1-7) episodes/month respectively, P = 0.77]. No recurrences of admissions were observed during Ramadan. There was a non-significant numerical tendency for more episodes in March and September (4.6 episodes for both) and fewer episodes in July (2.6 episodes) than other months; P values were 0.06; 0.13, and 0.32 respectively. This seasonality was not related to the month of Ramadan. CONCLUSIONS The present study confirmed that DKA admissions during Ramadan were not significantly higher than the average monthly admissions over ten years. Seasonality trends were not related to Ramadan.
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Affiliation(s)
- Anas S Beshyah
- Internal Medicine Residency Program, Institute of Education, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Division of Endocrinology, Institute of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
| | - Salem A Beshyah
- Division of Endocrinology, Institute of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
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Bashir M, Elhadd T, Ali H, Baagar K, Abdel Hakam IA, Al-Mohanadi DHS, Naem E, Al Abdulla A, Mohammed K, Abou-Samra AB. A pilot study using flash continuous glucose monitoring in patients with type-2 diabetes on multiple anti-diabetic agents during Ramadan. Diabetes Metab Syndr 2018; 12:965-968. [PMID: 29895446 DOI: 10.1016/j.dsx.2018.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 06/05/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study aims to examine the incidence of hypoglycaemia, based on activity, during Ramadan in patients with type 2 diabetes mellitus who were on were on three or more anti-diabetic medications. METHODS Type 2 diabetes patients who fasted during Ramadan and were on three or more anti-diabetic medications were studied for two weeks using flash glucose monitoring. The patients were asked to document all episodes of hypoglycaemia and were classified as active or sedentary according to their daytime activity. RESULTS The study included 16 patients of whom 10 were active and 6 were sedentary. There were 13 males and 3 females; mean age was 53.4 ± 6.4 years; mean diabetes duration was 15 ± 5.9 years, and mean HbA1C was 7.9 ± 1.3%. Over the two weeks; there were 7.9 episodes of hypoglycaemia recorded per patient; 50% of which were asymptomatic. There was no difference at baseline in age, BMI, HBA1C, diabetes duration, and anti-diabetic medications between the active and sedentary groups. The active group had better glucose control; median blood glucose was (7.1 (5.1-8.5) vs 10.6 (9.6-11.5) mmol p < 0.01), mean estimated HBA1C was (6.2 ± 1.2% vs 8.3 ± 1.0%; p = 0.047). The active group had more episodes of hypoglycaemia compared to the sedentary group (11.6 vs 1.8 hypo episode per patient/two weeks; p = 0.019); most of which were asymptomatic. CONCLUSION Patients with type 2 diabetes mellitus who are on three or more anti-diabetic medications should be warned about the increased risk of asymptomatic hypoglycaemia during Ramadan. Anti-diabetic medication adjustments during Ramadan should take into account the degree of activity. Flash glucose monitoring system can help patients to fast safely during Ramadan and detect asymptomatic hypoglycaemia.
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Affiliation(s)
- Mohammed Bashir
- Qatar Metabolic Institute, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Tarik Elhadd
- Qatar Metabolic Institute, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Hamda Ali
- Qatar Metabolic Institute, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Khaled Baagar
- Qatar Metabolic Institute, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ibrahim A Abdel Hakam
- Qatar Metabolic Institute, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Dabia H S Al-Mohanadi
- Qatar Metabolic Institute, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Emad Naem
- Qatar Metabolic Institute, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Amina Al Abdulla
- Qatar Metabolic Institute, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Kawsar Mohammed
- Qatar Metabolic Institute, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Abdul-Badie Abou-Samra
- Qatar Metabolic Institute, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
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Bashier A, Khalifa AA, Abdelgadir EI, Al Saeed MA, Al Qaysi AA, Bayati MBA, Alemadi B, Bachet F, Alawadi F, Hassanein M. Safety of Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2-I) During the Month of Ramadan in Muslim Patients with Type 2 Diabetes. Oman Med J 2018; 33:104-110. [PMID: 29657678 DOI: 10.5001/omj.2018.21] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives Sodium-glucose cotransporter 2 inhibitors (SGLT2-I) are a new class of antidiabetic drugs that might increase the risk of dehydration and hypoglycemia, particularly during the month of Ramadan in which Muslims abstain from eating and drinking for 14-16 hours daily. We aimed to provide real-life evidence about the safety of SGLT2-I during Ramadan. Methods All patients over the age of 18 years on SGLT2-I before Ramadan 2016 who would be fasting during Ramadan were included. Demographic data, detailed medical history including comorbidities and medication profile, and laboratory results were collected before and after Ramadan. We also conducted a phone interview to evaluate the frequency and severity of hypoglycemia and dehydration. Results Of the total of 417 patients, 113 (27.0%) experienced hypoglycemic events, and 93 of these (82.3%) checked their blood glucose using a glucometer. Confirmed hypoglycemia (< 70 mg/dL) was observed in 78 (83.8%). The hypoglycemic events were significantly more frequent in the SGLT2-I plus insulin-treated group than in those treated with SGLT2-I plus oral hypoglycemic agents group (p < 0.001). Confirmed hypoglycemic events were more frequent in those using SGLT2-I plus intensive insulin compared to those using SGLT2-I plus basal insulin (p = 0.020). Symptoms of dehydration were seen in 9.3% (n = 39) of the total population. We observed statistically significant reductions in glycated hemoglobin and weight by the end of Ramadan (p < 0.001). There were no significant changes in lipid profile and creatinine levels by the end of the study. Conclusions The use of insulin in combination with SGLT2-I increases the risk of hypoglycemia during Ramadan. Hypoglycemic events were mild and did not require hospital admission. However, careful monitoring during prolonged fasting is warranted. No significant harmful effects on renal function result from treatment with SGLT2-I during Ramadan.
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Affiliation(s)
| | | | | | | | | | | | | | - Fawzi Bachet
- Endocrine Department, Dubai Hospital, Dubai, UAE
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Affiliation(s)
- Kelly Grindrod
- University of Waterloo School of Pharmacy, Kitchener, Ontario
| | - Wasem Alsabbagh
- University of Waterloo School of Pharmacy, Kitchener, Ontario
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