Diabetic hypoglycaemia during Ramadan fasting: A trans-national observational real-world study
Affiliations
Affiliations
- 1Division of Endocrinology, Institute of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates. Electronic address: beshyah@yahoo.com.
- 2Diabetes and Endocrinology Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
- 3Baqai Institute of Diabetology & Endocrinology, Baqai Medical University, Karachi, Pakistan.
- 4K G N Diabetes & Endocrinology Centre, Mumbai, India.
- 5Diabetes and Endocrine Center, Dammam Medical Complex, Dammam, Saudi Arabia.
- 6Unit of Diabetes & Metabolism, Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
- 7Department of Diabetes and Endocrinology, Tawam Hospital, Al Ain, United Arab Emirates; Department of Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
- 8Diabetes Unit, Amiri Hospital, Ministry of Health, Kuwait City, Kuwait.
Abstract
Objectives: To describe the risk of hypoglycaemia during Ramadan and determine its risk factors, and the impact of hypoglycaemia on patients' behaviour.
Methods: A cross-sectional multi-country observational study, with data captured within 6 weeks after Ramadan 2015. Patients' and disease characteristics and its management, the risk of hypoglycaemia and patients' response to hypoglycaemia were recorded.
Results: A cohort of 1759 patients; majority with type 2 diabetes mellitus from North Africa, Arabian Gulf, Saudi Arabia, and the Indian subcontinent. Hypoglycaemia was reported by 290 patients (16.8%); particularly affecting type 1 diabetes patients and in insulin-treated patients in general. Age was significantly younger in the hypoglycaemia group (P < 0.001). The commonest responses were reducing the dose or frequency of medications (42%), attending primary care providers (24.5%) or increasing monitoring (20.7%). Fasting was interrupted by 67% only of those who experienced hypoglycaemia and recourse to emergency services was pursued by less than a quarter of patients with hypoglycaemia. The country-wise analysis of the rates of hypoglycaemia was greatest in Egypt (51.3%) and lowest in Pakistan (3.5%).
Conclusions: Hypoglycaemia is a significant complication of fasting during Ramadan. It may be predicted by type of diabetes, and use of insulin. Patients' responses are varied and call for more formal pre-Ramadan education.
Keywords: Diabetes; Fasting; Hypoglycaemia; Insulin therapy; Ramadan.
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