Department of Endocrinology, Diabetes and Nutrition Department, Hôpital Nord, Chemin des Bourrely, 13015 Marseille, France.
Diabetes Metab. 2011 Nov;37(5):395-402. doi: 10.1016/j.diabet.2010.12.010. Epub 2011 Apr 8.
The aim of this study was to evaluate attitudes in hospital inpatients and physicians towards Ramadan fasting and diabetes in Marseille.
This cross-sectional study was conducted during the three months prior to the month of Ramadan. A total of 101 patients (age: 57±17 years) and 101 general practitioners (GPs) were recruited into the study.
The patients had low levels of education (52% illiteracy). Of the 101 patients, 52 continued to fast during Ramadan, and only 65 patients had discussed the matter with their GP. Of these, 36 were told that fasting was forbidden, but more than half (n=19) fasted despite the medical advice. Six patients thus experienced daily hypoglycaemia because they had continued to take their hypoglycaemic agent or insulin analogue at noon. Both inadequate education and religious attitudes were found to endanger patients during the fast: 15 patients skipped the meal scheduled before dawn, five of whom persisted in taking their sulphonylurea. Also, 27% of patients refused, in spite of daytime hypoglycaemia, to ingest anything orally to avoid breaking their fast. Among the GP population, medical knowledge of Ramadan fasting with diabetes was low, leading to medically unjustified negative advice for fasting and a lack of patient education on adjusting treatments. This particular situation weakened the patient-physician relationship.
This study confirms the importance of Ramadan fasting for Muslim patients, and reveals a wide cross-cultural gap between GPs and their patients. Systematic advice on treatment adjustment needs to be given. For this reason, we encourage more sensitive care of these patients and more medical training for physicians.
本研究旨在评估马赛医院住院患者和医生对开斋节斋戒和糖尿病的态度。
这是一项在开斋节前三个月进行的横断面研究。共招募了 101 名患者（年龄：57±17 岁）和 101 名全科医生（GP）。
患者受教育程度较低（52%为文盲）。在 101 名患者中，52 名继续在开斋节期间斋戒，只有 65 名患者与他们的全科医生讨论过此事。其中，36 人被告知禁食是禁止的，但超过一半（n=19）人不顾医嘱禁食。因此，有 6 名患者每天出现低血糖，因为他们在中午继续服用降糖药或胰岛素类似物。教育不足和宗教态度都被认为使患者在斋戒期间处于危险之中：15 名患者跳过黎明前的一餐，其中 5 名患者继续服用磺酰脲类药物。此外，尽管白天出现低血糖，仍有 27%的患者拒绝口服任何东西来避免打破斋戒。在全科医生群体中，对开斋节斋戒与糖尿病相关的医学知识知之甚少，导致对斋戒的医学上不合理的否定建议，以及对调整治疗方法的患者教育不足。这种特殊情况削弱了医患关系。
本研究证实了开斋节斋戒对穆斯林患者的重要性，并揭示了全科医生及其患者之间广泛的跨文化差距。需要对治疗调整提供系统的建议。为此，我们鼓励更加关注这些患者的医疗护理，并为医生提供更多的医学培训。
