Muslims, Ramadan, and diabetes mellitus

Having diabetes and having to fast: a qualitative study of British Muslims with diabetes

BACKGROUND

There are approximately 2.7 million Muslims in the UK, constituting 4.8% of the population. It is estimated that 325,000 UK Muslims have diabetes. Whilst dietary practices of Muslims with diabetes have been explored, little work has described the beliefs and decisions to fast during Ramadan, whereby Muslims with diabetes refrain from eating, drinking and taking medication between sunrise and sunset.

OBJECTIVE

To explore beliefs and experiences of fasting during Ramadan of Muslim respondents with diabetes and their perceptions of the role played by their general practitioner (GP) and/or practice nurse (PN) in supporting them.

DESIGN

Qualitative study.

SETTING

General practices and community groups located in Greater Manchester.

PARTICIPANTS

23 South Asian Muslims.

METHODS

Semi-structured interviews were conducted as part of the Collaboration of Applied Health Research and Care (CLAHRC) programme, Greater Manchester. Respondents were recruited using random and purposive sampling techniques. Interviews were analysed thematically using a constant comparison approach.

RESULTS

Thirteen respondents reported they fasted and altered diabetes medication and diet during Ramadan. The decision to fast was influenced by pressures from the family and the collective social aspect of fasting, and respondents made limited contact with primary care during fasting.

CONCLUSION

Tensions exist between the respondent's personal desire to fast or not fast and their family's opinion on the matter, with a strong reluctance to disclose fasting to GP and/or PN. Future research needs to explore whether GPs or PNs feel competent enough to support patients who wish to fast.

Religion and self-management of Thai Buddhist and Muslim women with type 2 diabetes

AIMS AND OBJECTIVES

To report of a qualitative study of how religion affects the self-management of Thai Buddhist and Muslim women with type 2 diabetes.

BACKGROUND

The importance of diabetes self-management is well recognised. However, research on such self-management in Thailand is scarce, in particular on the influence of religion on the self-management of Thai Buddhist and Muslim women with type 2 diabetes.

DESIGN

A descriptive qualitative study was conducted.

METHODS

Purposive convenience sampling was used, and 48 women, 19 Buddhist and 29 Muslim, aged from 28-80 years, participated. Data were collected in 2008-09 and analysed by use of manifest and latent content analysis.

RESULTS

Four themes of the influence of religion on the self-management among Thai women with type 2 diabetes emerged: religion - a way of coping with diabetes, spiritual practice - a help for disease control, spiritual practice - an effort to struggle with everyday life, and support from family - a cultural practice.

CONCLUSIONS

The Buddhist and Muslim women had self-management capabilities that were often related to their religions. However, many of them had poor control of their blood sugar levels and needed assistance.

RELEVANCE TO CLINICAL PRACTICE

Reference to religion and spiritual practice can be an effective means of helping diabetes patients better manage their disease and change their lifestyles. Furthermore, family and economic and social environments should be taken into account both in care and in interventions aimed at helping patients cope and empowering them to control their disease.

Dose Ramadan Fasting Affects Inflammatory Responses: Evidences for Modulatory Roles of This Unique Nutritional Status via Chemokine Network

OBJECTIVE(S)

The impact of fasting in Ramadan as a unique type of nutritional regimen on biochemical and hematological parameters is still an issue of debate. Almost very little is known regarding the regulatory role(s) of this nutritional status on immune responses or inflammation.

MATERIALS AND METHODS

The levels of biochemical parameters were determined using commercial diagnostic kits. Hematological parameters were also examined. We also employed ELISA for detection of CXCL1, CXCL10 and CXCL12 chemokines. The Student-T test was used to compare the values of different parameters obtained in the first and last day of Ramadan fasting by employing SPSS (version 18) software.

RESULTS

As our findings demonstrated, there was a markedly difference between before and after Ramadan BMI of the individuals who fast. Our results also revealed that there was a remarkable difference between the levels of total cholesterol, FBS, Triglycerides and LDL before and after Ramadan fasting. RESULTS revealed that among studied hematological parameters only the numbers of platelets were markedly different before and after Ramadan fasting program in individuals who practice fasting. Our results also showed decreased levels of pro-inflammatory CXC chemokines but unaltered levels of homoeostatic ones.

CONCLUSION

The results of this study may reveal that Ramadan fasting is quite safe for normal healthy adults and so very useful in reduction of cholesterol and triglycerides in relation with dyslipidemia. It is also possible to conclude that fasting is important in controlling of inflammation via chemokines.

Diabetes and Ramadan: review of the literature

During the month of Ramadan, Muslims fast every day from dawn to sunset. In the healthy subject, this fasting does not have any harmful consequences on health. However, it can induce several complications for patients with diabetes. The aim of this review twofold: first, it seeks to give some clues about methodological aspect of research during Ramadan and to show the impact of various diabetes monitoring and treatment, including biochemical and clinical parameters, diet and caloric intake, drug intake when fasting. Second, it intends to determine whether or not Ramadan fasting induces complications in patients with types 1 and 2 diabetes and ultimately to elaborate some advice as to the management of fasting patients. Several studies have shown that Ramadan fasting did not alter biochemical parameters in patients with type 2 diabetes. However, other studies have shown that there is either an increase or a decrease in biochemical parameters during Ramadan. Ramadan fasting would be acceptable for patients with well-balanced type 2 diabetes who are conscious of their disease and compliant with their diet and drug intake. If patients with type 1 diabetes wish to fast, it is necessary to advise them to undertake control of their glycaemia several times a day. Patients with type 1 diabetes who will fast during Ramadan may be better managed with fast absorption insulin.

[Clinical case: beliefs, Ramadan and diabetes mellitus]

From the clinical case of a 52-Year old, type 2 diabetic obese woman, muslim algerian native, an endocrinologist and a religious representative discuss the influences of religion, beliefs and environment, on compliance to the diabetes diet and therapeutic management, with a particular emphasis on the Ramadan period. Inadequate behaviours, result in a worsening in glucose control. This, should be avoided through an appropriate patient's education, all along the Year, not only through the healthcare team, but involving patient's family and friends too, as well as the community and religious Authorities.

Management of people with diabetes during Ramadan

In the UK, Islam is the second largest religion after Christianity and there are about 2.5 million Muslims living in the UK. Fasting is obligatory for all healthy adult Muslims during the holy month of Ramadan. During Ramadan, no food, drink, or medication is allowed between dawn and sunset. As a result of different research results there is no agreement on whether it is safe for Muslim diabetics to fast. Through dialogue between health professionals and patients, it is usually possible to facilitate at least some safe fasting for those who wish to observe this annual ritual. In this article some key pointers will be given for health professionals to consider with the aim of improving the quality of care of Muslim patients with diabetes during Ramadan.

Insulin lispro (Lys(B28), Pro(B29) in the treatment of diabetes during the fasting month of Ramadan. Ramadan Study Group

AIMS

To compare insulin lispro with soluble human insulin in patients with Type 2 diabetes mellitus fasting during Ramadan, with respect to the rate of hypoglycaemic episodes and postprandial blood glucose values after the main meal after sunset.

METHODS

The insulins were compared in an open-label, randomized, cross-over study of 70 outpatients. Hypoglycaemic episodes were recorded by the patients in a self-monitoring diary. Fasting, 1-h and 2-h postprandial blood glucose values were recorded by the patient on three consecutive days at the end of each treatment period.

RESULTS

The fasting blood glucose values before sunrise (P>0.4) and after sunset (P>0.6) were similar and did not differ significantly between both treatment groups. The rise in blood glucose after the main meal after sunset was 3.0+/-0.4 mmol/l after 1 h in the insulin lispro treatment group compared to 4.3+/-0.4 mmol/l in the soluble insulin treatment group (P<0.01), and 2.6+/-0.4 mmol/l after 2h with insulin lispro compared to 4.0+/-0.5 mmol/l with soluble insulin (P<0.008). Mean hypoglycaemic episodes per patient over 14 days were 1.3+/-0.1 vs. 2.6+/-0.2, P<0.002, respectively, for insulin lispro and soluble insulin. Most hypoglycaemic episodes occurred during the time period from 6 h after the before sunrise meal until breaking the fast after sunset.

CONCLUSIONS

The significantly lower rate of hypoglycaemic episodes combined with better control of postprandial blood glucose suggest insulin lispro may be more suitable prandial insulin for patients treated with Type 2 diabetes who fast during Ramadan.

Metabolic changes in Asian Muslim pregnant mothers observing the Ramadan fast in Britain

1. Metabolic changes associated with Ramadan fasting were studied in eleven Asian pregnant mothers. This was compared with a group of control mothers undergoing a normal physiological fast. 2. At the end of the Ramadan fast day there was a significant fall in glucose, insulin, lactate and carnitine, and a rise in triglyceride, non-esterified fatty acid and 3-hydroxybutyrate. When compared with the control group, none of the Ramadan mothers had a completely normal set of biochemical values at the end of the fast day. 3. Pregnancy outcome in the two groups was comparable. 4. We are wary of the metabolic departures from normal observed in the Ramadan fasting mothers. If asked we advise mothers to take up the dispensation from fasting during pregnancy which is allowed.