Ochani Rohan Kumar, Shaikh Asim, Batra Simran, Pikale Gauri, Surani Salim
Internal Medicine, SUNY Upstate Medical University Hospital, Syracuse, NY 13210, United States.
Medicine, Aga Khan University, Sindh, Karachi 74500, Pakistan.
World J Clin Cases. 2023 Sep 16;11(26):6031-6039. doi: 10.12998/wjcc.v11.i26.6031.
Fasting during the month of Ramadan is one of the five fundamental principles of Islam, and it is obligatory for healthy Muslim adults and adolescents. During the fasting month, Muslims usually have two meals a day, suhur (before dawn) and iftar (after dusk). However, diabetic patients may face difficulties when fasting, so it is important for medical staff to educate them on safe fasting practices. Prolonged strict fasting can increase the risk of hypoglycemia and diabetic ketoacidosis, but with proper knowledge, careful planning, and medication adjustment, diabetic Muslim patients can fast during Ramadan. For this review, a literature search was conducted using PubMed and Google Scholar until May 2023. Articles other than the English language were excluded. Current strategies for managing blood sugar levels during Ramadan include a combination of patient education on nutrition, regular monitoring of blood glucose, medications, and insulin therapy. Insulin therapy can be continued during fasting if properly titrated to the patients' needs, and finger prick blood sugar levels should be assessed regularly. If certain symptoms such as hypoglycemia, hyperglycemia, dehydration, or acute illness occur, or blood glucose levels become too high (> 300 mg/dL) or too low (< 70 mg/dL), the fast should be broken. New insulin formulations such as pegylated insulin and medications like tirzepatide, a dual agonist of gastric-inhibitory peptideand glucagonlike-peptide 1 receptors, have shown promise in managing blood sugar levels during Ramadan. Non-insulin-dependent medications like sodium-glucose-cotransporter-2 inhibitors, including the Food and Drug Administration-approved ertugliflozin, are also being used to provide additional cardiovascular benefits in patients with type 2 diabetes.
斋月禁食是伊斯兰教的五大基本教义之一，健康的成年和青少年穆斯林有义务遵守。在斋月期间，穆斯林通常一天吃两餐，即封斋饭（黎明前）和开斋饭（日落后）。然而，糖尿病患者在禁食期间可能会面临困难，因此医护人员对他们进行安全禁食做法的教育很重要。长期严格禁食会增加低血糖和糖尿病酮症酸中毒的风险，但通过正确的知识、精心的规划和药物调整，糖尿病穆斯林患者可以在斋月期间禁食。为了进行本综述，我们使用PubMed和谷歌学术进行了文献检索，截至2023年5月。排除非英文文章。斋月期间管理血糖水平的当前策略包括对患者进行营养教育、定期监测血糖、药物治疗和胰岛素治疗相结合。如果根据患者需求适当调整剂量，禁食期间可以继续胰岛素治疗，并且应定期评估指尖血糖水平。如果出现低血糖、高血糖、脱水或急性疾病等特定症状，或者血糖水平变得过高（>300mg/dL）或过低（<70mg/dL），则应停止禁食。聚乙二醇化胰岛素等新型胰岛素制剂以及胃抑制肽和胰高血糖素样肽1受体双重激动剂替尔泊肽等药物在斋月期间管理血糖水平方面已显示出前景。钠-葡萄糖协同转运蛋白-2抑制剂等非胰岛素依赖型药物，包括美国食品药品监督管理局批准的依鲁格列净，也被用于为2型糖尿病患者提供额外的心血管益处。
