Knowledge, attitude, and practices of fasts in patients with type 2 diabetes among different religions in North India

  • 22 Accesses


Background and objectives

There is no data regarding knowledge, attitude, and practices (KAP) of fasts in subjects with type 2 diabetes (T2DM) among different religions in India. Study was done to assess KAP regarding fasts among subjects with T2DM from various religions.

Material and methods

A total of 300 consecutive participants with T2DM (age ≥ 25 years) from 3 diabetes clinics in North India after consent were subjected to predesigned study pro forma.


A total of 300 subjects participated in the study with 76.3% being Hindus, 11% Muslims, 4.3% Sikhs, and 5.7% from other religions (Christians and Buddhists). Knowledge and attitude regarding fasts in context of diabetes were poor in majority of subjects. 59.7% participants agreed that diabetic patients can fast. 36.3% participants believed that people with poor glycemic control (HbA1c ≥ 10%) can also observe fast. 40.7% believed medicines/insulins are not allowed during fasts because of religious reasons. 46.7% participants were aware of hypoglycemic symptoms. Among Hindus 2 most common fasts were Navratri (observed by 53%) and Karva Chauth (observed by 47.6%). Overall, 66.7% of Muslims observed Ramadan. Only 1.3% of participants discussed with their doctors before observing fast. 51.7% of participants who observed fasts had symptoms suggestive of hypoglycemia during fasts. 60.4% of subjects missed their medications during fasting. 28.8% altered their drug regimen by themselves without doctors’ consultation. 78.5% of participants observed fasts because of social obligations. Hindus were more likely to consult doctors during fasts and experienced comparatively lesser hypoglycemia and hyperglycemia as compared with Muslims and other religions. Women had greater inhibition to disclose about diabetes during fasts, were more likely to consult doctor during fasts, and perceived greater changes in body weight, hypoglycemia, and hyperglycemia during fasts.


The study showed significant gaps in knowledge and attitude regarding fasts among subjects with T2DM, in spite of fasting being common among all religions. The different nature and duration of different fasts and associated religious practices may contribute to these differences.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.


  1. 1.

    Dutta D, Mukhopadhyay S. Intervening at prediabetes stage is critical to controlling the diabetes epidemic among Asian Indians. Indian J Med Res. 2016;143(4):401–4.

  2. 2.

    Dutta D, Choudhuri S, Mondal SA, Mukherjee S, Chowdhury S. Urinary albumin: creatinine ratio predicts prediabetes progression to diabetes and reversal to normoglycemia: role of associated insulin resistance, inflammatory cytokines and low vitamin D. J Diabetes. 2014;6(4):316–22.

  3. 3.

    Dutta D, Maisnam I, Shrivastava A, Sinha A, Ghosh S, Mukhopadhyay P, et al. Serum vitamin-D predicts insulin resistance in individuals with prediabetes. Indian J Med Res. 2013;138(6):853–60.

  4. 4.

    Dutta D, Mondal SA, Choudhuri S, Maisnam I, Hasanoor Reza AH, Bhattacharya B, et al. Vitamin-D supplementation in prediabetes reduced progression to type 2 diabetes and was associated with decreased insulin resistance and systemic inflammation: an open label randomized prospective study from Eastern India. Diabetes Res Clin Pract. 2014;103(3):e18–23.

  5. 5.

    Kalra S, Bajaj S, Gupta Y, Agarwal P, Singh SK, Julka S, et al. Fasts, feasts and festivals in diabetes-1: glycemic management during Hindu fasts. Indian J Endocrinol Metab. 2015;19:198–203.

  6. 6.

    Gupta L, Khandelwal D, Singla R, Gupta P, Kalra S. Pragmatic dietary advice for diabetes during Navratris. Indian J Endocr Metab. 2017;21:231–7.

  7. 7.

    Almalki MH, Alshahrani F. Options for controlling type 2 diabetes during Ramadan. Front Endocrinol (Lausanne). 2016;7:32.

  8. 8.

    Al-Arouj M, Assaad-Khalil S, Buse J, Fahdil I, Fahmy M, Hafez S, et al. Recommendations for management of diabetes during Ramadan: update 2010. Diabetes Care. 2010;33:1895–902.

  9. 9.

    Elhadd TA, Al-Amoudi AA. Recommendations for management of diabetes during Ramadan. Diabetes Care. 2006;29:744–5.

  10. 10.

    Available from: Ramadan-and-diabetes-A-guide-for-patients-2013.pdf. [Last accessed on 2015 Aug 15].

  11. 11.

    Hosseini S, Rajabzadeh R, Akhoundan M, Mohaddes HH, Tavakoli H, Niyazi M. Knowledge of diabetic patients about fasting, referred to diabetic clinic at Bojnord district 2015. Journal Of North Khorasan University Of Medical Sciences 2016;8(4):665-673

  12. 12.

    Zainudin SB, Ang DY, Soh AW. Knowledge of diabetes mellitus and safe practices during Ramadan fasting among Muslim patients with diabetes mellitus in Singapore. Singap Med J. 2017;58(5):246–52.

  13. 13.

    Yaacob N, Ismail AA, Wan Bebakar WM. Knowledge, attitude and practice of type 2 diabetes mellitus patients on Ramadan fasting at Hospital Universiti Sains Malaysia. J IMA. 2007;39:6–12.

  14. 14.

    Gaborit B, Dutour O, Ronsin O, Atlan C, Darmon P, Gharsalli R, et al. Ramadan fasting with diabetes: an interview study of inpatients’ and general practitioners’ attitudes in the South of France. Diabetes Metab. 2011;37:395–402.

  15. 15.

    Beshyah SA, Farooqi MH, Farghaly M, Abusnana S, Al Kaabi JM, Benbarka MM. Management of diabetes during Ramadan fasting: a comprehensive survey of physicians’ knowledge, attitudes and practices. Ibnosina Journal of Medicine and Biomedical Sciences. 2017;9(2):28–36

  16. 16.

    Almansour HA, Chaar B, Saini B. Fasting, diabetes, and optimizing health outcomes for Ramadan observers: a literature review. Diabetes Ther. 2017;8(2):227–49.

  17. 17.

    Al Slail FY, Afridi HU, Fadl SM, Kheir OO. Levels of health awareness in diabetic patients during Ramadan 2015: focus group discussion in Riyadh, Saudi Arabia. Journal of Epidemiology and Global health. 2018;7:S49–54.

  18. 18.

    Mikhael EM, Sabri ZZ, Jasim AL. Knowledge and attitude of Iraqi diabetic patients who fast during Ramadan. International Journal of Phytopharmacology. 2016;7(2):58-62.

  19. 19.

    Almalki MH, Hussen I, Khan SA, Almaghamsi A, Alshahrani F. Assessment of Ramadan Education and Knowledge Among Diabetic Patients. Clin Med Insights Endocrinol Diabetes. 2018;11:1179551417751611

  20. 20.

    Dutta D, Biswas K, Sharma M, Maskey R, Baruah MP, Amin MF. Managing diabetes during Navratris with special focus on Durga pujas. J Soc Health Diabetes. 2015;3:84–8.

  21. 21.

    Salti I, Benard E, Detournay B, Bianchi-Biscay M, Le Brigand C, Voinet C, et al. A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diabetes Care. 2004;27(10):2306–11.

  22. 22.

    Bravis V, Hui E, Salih S, Mehar S, Hassanein M, Devendra D. Ramadan Education and Awareness in Diabetes (READ) programme for Muslims with type 2 diabetes who fast during Ramadan. Diabet Med. 2010;27(3):327–31.

  23. 23.

    Dutta D, Chowdhury S. Glycemic emergencies: diabetic ketoacidosis, hyperosmolar nonketotic hyperglycemia, and hypoglycemia. In: Bajaj S, editor. ESI manual of clinical endocrinology, vol. 2. 2nd ed. New Delhi: Jaypee; 2014. p. 1–9.

  24. 24.

    Kaushal K, Raina SK. “Risk approach strategy” in diabetics on fasting-evidence base through narrative review with a special focus on Ramadan fasting. J Soc Health Diabetes. 2015;3:11–5.

  25. 25.

    Gaborit B, Dutour O, Ronsin O, Atlan C, Darmon P, Gharsalli R, Pradel V, Dadoun F, Dutour A. Ramadan fasting with diabetes: an interview study of inpatients’ and general practitioners’ attitudes in the South of France. Diabetes Metab. 2011;37(5):395-402.

  26. 26.

    Pinelli NR, Jaber LA. Practices of Arab American patients with type 2 diabetes mellitus during Ramadan. J Pharm Pract. 2011;24(2):211–5.

Download references

Author information

Correspondence to Deep Dutta.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Arora, B., Gupta, L., Khandelwal, D. et al. Knowledge, attitude, and practices of fasts in patients with type 2 diabetes among different religions in North India. Int J Diabetes Dev Ctries (2019).

Download citation


  • Diabetes
  • Fast
  • Religion
  • Hindu fast
  • Navratri
  • Karva Chauth
  • Ramadan
  • Diet
  • Knowledge