Diabetic hypoglycaemia during Ramadan fasting: A trans-national observational real-world study

• Published in: Diabetes research and clinical practice Vol. 150; pp. 315 - 321
• Main Authors: Beshyah, Salem A., Hassanein, Mohamed, Ahmedani, M. Yakoob, Shaikh, Shehla, Ba-Essa, Ebtesam M., Megallaa, Magdy H., Afandi, Bachar, Ibrahim, Fawzi, Al-Muzaffar, Talal
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-04-2019
• Subjects: Diabetes; Fasting; Hypoglycaemia; Insulin therapy; Ramadan; Insulin therapy; Fasting; Diabetes; Ramadan; Hypoglycaemia
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2019.01.039

To describe the risk of hypoglycaemia during Ramadan and determine its risk factors, and the impact of hypoglycaemia on patients' behaviour.
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.
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%).
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.