Diabetes during Ramadan - PRE-approach model: presentation, risk stratification, education.

OBJECTIVE

Fasting (Sawm) during Ramadan is one of the five pillars of Islam and mandatory for all Muslim healthy adults. Most of the Muslim diabetic patients insist on fasting in Ramadan despite their exemption. Due to paucity of literature, diabetes during Ramadan is underestimated and the statistics are not reflecting the actual reality. The aim of this study is to highlight the demographics in diabetic Muslim population and emphasize its ramifications on Ramadan fasting.

METHODS

In this study, we developed a 3 step PRE-approach model based on Presentation, Risk stratification, Education in diabetics who fast during Ramadan. For the establishment of this model we identified 40 published studies in database searches including ISI-web of science and pub-med. We searched the related literature by using the key words including diabetes mellitus, Ramadan fasting. All studies in which diabetes and fasting in Ramadan was investigated were included. There was no limitation on publication status, design or language. Finally, we included 35 publications and remaining 5 were excluded from the study.

RESULTS

The diabetic patients who fast are at risk of severe hypoglycemia, hyperglycemia, diabetic ketoacidosis, dehydration, thrombosis, strokes and retinal artery occlusion. Lack of education, poor healthcare and no structured guidance cause adeverse health consequences.

CONCLUSIONS

It is vital to empower the healthcare workers and the patients in the frontlines with appropriate information. To preempt and minimize the problems faced by the diabetic patients who fast, available resources should be mobilized to efficiently and effectively reach out these patients. Diabetic patient educational guidelines about Ramadan fasting should be disseminated and translated into major regional languages to minimize the complications. Diabetic patients who are stable, free of deteriorating complications and able to manage can be allowed to fast.