Fasting Ramadan in patients with T1DM - Saudi Arabia versus other countries during the COVID-19 pandemic

BACKGROUND AND AIMS

To compare Saudi Arabia with other countries regarding patient attitudes towards fasting Ramadan and complications related to fasting during the COVID-19 pandemic.

METHODS

Data collected from Saudi Arabia and 12 other mostly Muslim majority countries, via physician administered questionnaire within post Ramadan 2020.

RESULTS

1485 Type1 diabetes (T1DM) patients analyzed; 705 (47.5%) from Saudi Arabia vs. 780 (52.5%) from other countries. 1056 (71.1%) fasted Ramadan; 636 (90.2%) of Saudi patients vs. 420 (53.8%) of other countries. Experiencing Ramadan during the COVID-19 pandemic did not affect the Saudi T1DM patients' decision to fast while it significantly influenced their decision in other countries (1.4 vs 9.9%, P < 0.001). More Saudi patients needed to break the fast due to a diabetes related complication compared to other countries (67.4% vs. 46.8%, p=<0.001). The mean number of days fasted in Saudi and other countries was 24 ± 7 and 23 ± 8 days respectively. Hypoglycemic events were more common among Saudi patients during Ramadan compared to other countries 72% and 43.6% (p < 0.001) respectively. There was a significant difference in timing; the largest peak for Saudi Arabia patients was after dawn (35% vs 7%, p < 0.001), while it was pre-sunset for the other countries (23 vs 54%, p = 0.595). Day time-hyperglycemia was also more common among Saudi patients (48.6% vs. 39%, p < 0.001), however it was a less likely cause to break the fast (25.6% vs 38.3%, p < 0.001).

CONCLUSION

Observing the fast of Ramadan is extremely common among Saudi T1DM patients compared to other Muslim countries and was not affected by the COVID-19 pandemic. However, it was associated with higher frequency of hypoglycemic and hyperglycemic episodes.

Evaluation of glycemic control among Type 2 diabetic patients in the first visit after COVID-19 lockdown, Prince Mansour Military Hospital, Taif, Saudi Arabia

Background

The coronavirus disease (COVID-19) pandemic causes significant morbidities and mortalities. Lockdown is applied worldwide to counteract the spread of the disease. These circumstances limit diabetic patients from hospital visits and follow-ups.

Objectives

To evaluate glycemic control for type 2 diabetic patients in the first visit after COVID-19 lockdown and to study the effect of COVID-19 lockdown on glycemic control.

Methods

A cross-sectional study was conducted at Prince Mansour Military Hospital, Taif city, Western Saudi Arabia. It included type 2 diabetic patients of both genders aged over 20 years that were assigned to follow-up in the diabetic center. Data were collected from patients' medical records using a simple random technique. It included patients` gender, age group, body mass index, and three glycosylated hemoglobin (HbA1c) readings for each year (2018-2019) and one HbA1C reading upon the first visit after COVID-19 lockdown. HbA1c level was treated as a continuous variable.

Results

The study included 420 diabetic patients. Females represented 51% of them, and more than a third (39.8%) were aged 60 years and over. The majority of them were either overweight (29.3%) or obese (61.2%). There was an increase in the overall level of HbA1c after curfew (8.72 ± 1.73) than before it (8.58 ± 1.72). However, the difference did not reach a statistically significant level, P = 0.056. Among females, the level of hemoglobin A1c (HbA1c) was statistically and significantly higher after curfew than before it (8.71 ± 1.82 vs. 8.43 ± 1.71), P = 0.005. Also, among obese subjects, the level of hemoglobin A1c was statistically and significantly higher after curfew than before it (8.55 ± 1.74 vs. 8.34 ± 1.63), P = 0.034.

Conclusion

There was a relative increase in the level of HbA1c after the lockdown during COVID-19, indicating poorer glycemic control; this impact was more obvious among female and obese type 2 diabetic patients.

Ramadan fasting in people with type 1 diabetes during COVID-19 pandemic: The DaR Global survey

OBJECTIVES

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).

METHODS

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.

RESULTS

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.

CONCLUSION

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.