To assess the awareness level and care of people with diabetes related to Ramadan fasting across the country.
This cross-sectional survey was conducted by Baqai Institute of Diabetology and Endocrinology, between November 2016 to March 2017, using convenient sampling. The physicians involved in the care of people with diabetes were invited to participate. A preformed validated questionnaire was used to conduct face to face interview on one to one basis.
Altogether 2187 people with diabetes were enrolled. Knowledge related to Ramadan fasting was poor (35.64%), misconceptions were common (57.02%), and unsafe practices (55.62%) were highly prevalent. One third (31.9%) of the subjects did not receive pre-Ramadan education while medications adjustments were not made in nearly half of the study population.
In this cross-sectional survey, we observed lack of awareness, misconceptions and unsafe practices among fasting people with diabetes across the country. Large scale awareness campaign is needed as comprehensive care is not widely available.
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Hassanein M, Al-Arouj M, Hamdy O, Bebakar WM, Jabbar A, Al-Madani A, et al. Diabetes and Ramadan: practical guidelines. Diabetes Res Clin Pract. 2017;126:303–16.
Abdullah YA, translator. The Qur’an. Ch. 2, Ver. 187. New York: TahrikeTarsile Qur’an Inc; 2003.
Salti I, Bénard E, Detournay B, Bianchi-Biscay M, Le Brigand C, Voinet C, et al. 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.
Ahmedani MY, Alvi SF. Characteristics and Ramadan-specific diabetes education trends of patients with diabetes (CARE): a multinational survey (2014). Int J Clin Pract. 2016;70(8):668–75.
Karamat MA, Syed A, Hanif W. Review of diabetes management and guidelines during Ramadan. J R Soc Med. 2010;103(4):139–47.
Masood SN, Masood Y, Mumtaz SN, Maqsood A, Hakim R, Shaikh Z, et al. Ramadan fasting related awareness, practices and experiences of a representative group of Urban Pakistani Diabetics. Pakistan Journal of Medical Sciences. 2012;28(3):432–6.
Bravis V, Hui E, Salih S, Mehar S, Hassanein M, Devendra D. Ramadan Education and Awareness in Diabetes (READ) program for Muslims with Type 2 diabetes who fast during Ramadan. Diabet Med. 2010;27(3):327–31.
Ahmedani MY, Ahsan S, ulHaque MS. Role of Ramadan specific diabetes education (RSDE); A prospective study. Pakistan Journal of Medical Sciences. 2017;33(3):586.
Masood SN, Alvi SF, Ahmedani MY, Kiran S, Zeeshan NF, Basit A, et al. Comparison of Ramadan-specific education level in patients with diabetes seen at a primary and a tertiary care center of Karachi-Pakistan. Diabetes Metab Syndr. 2014;8(4):225–9.
Salti I, Bénard E, Detournay B, Bianchi-Biscay M, Le Brigand C. Voinet C, 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.
Ahmedani MY, Alvi SF, Fawwad A, Ul-haque MS, Naz S, Basit A. Safety of fasting in patients with Type 1 diabetes during Ramadan: a prospective study from Pakistan. British Journal of Medicine and Medical Research 19(9): 1-8, 2017
Al-Arouj M, Assaad-Khalil S, Buse J, Fahdil I, Fahmy M, Hafez S, et al. Recommendations for management of diabetes during Ramadan. Diabetes Care. 2010;33(8):1895–902.
Hakeem R, Ahmedani MY, Alvi SF, Ulhaque MS, Basit A, Fawwad A. Dietary patterns and glycemic control and compliance to dietary advice among fasting patients with diabetes during Ramadan. Diabetes Care. 2014;37(3):e47–8.
Mann JI, De Leeuw I, Hermansen K, Karamanos B, Karlström B, Katsilambros N. Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus. Nutr Metab Cardiovasc Dis. 2004;14(6):373–94.
Franz MJ, Powers MA, Leontos C, Holzmeister LA, Kulkarni K, Monk A. The evidence for medical nutrition therapy for type 1 and type 2 diabetes in adults. J Am Diet Assoc. 2010;110(12):1852–89.
Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014;37(Supplement 1):S120–43.
Sheard NF, Clark NG, Brand-Miller JC, Franz MJ, Pi-Sunyer FX, Mayer-Davis E. Dietary carbohydrate (amount and type) in the prevention and management of diabetes: a statement by the American Diabetes Association. Diabetes Care. 2004;27(9):2266–71.
Dyson PA, Kelly T, Deakin T, Duncan A, Frost G, Harrison Z. Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes. Diabet Med. 2011;28(11):1282–8.
Bantle JP, Wylie-Rosett J, Albright AL, Apovian CM, Clark NG, Franz MJ. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008;31:S61–78.
Allemann S, Houriet C, Diem P, Stettler C. Self-monitoring of blood glucose in non-insulin treated patients with type 2 diabetes: a systematic review and meta-analysis. Curr Med Res Opin. 2009;25(12):2903–13.
Schnell O, Hanefeld M, Monnier L. Self-monitoring of blood glucose: a prerequisite for diabetes management in outcome trials. J Diabetes Sci Technol. 2014;8(3):609–14.
Schwedes U, Siebolds M, Mertes G. Meal-related structured self-monitoring of blood glucose: effect on diabetes control in non-insulin-treated type 2 diabetic patients. Diabetes Care. 2002;25(11):1928–32.
Peel E, Parry O, Douglas M, Lawton J. Blood glucose self-monitoring in non-insulin-treated type 2 diabetes: a qualitative study of patients’ perspectives. Br J Gen Pract. 2004;54(500):183–8.
Schnell O, Alawi H, Battelino T, Ceriello A, Diem P, Felton AM. Self-monitoring of blood glucose in type 2 diabetes: recent studies. J Diabetes Sci Technol. 2013;7(2):478–88.
Chiari G, Ghidini B, Vanelli M. Effectiveness of a toll-free telephone hotline for children and adolescents with type 1 diabetes. A 5-year study. Acta Biomed. 2003;74(1):45–8.
Joseph, P. The effectiveness of telephone consultation in the management of patients with diabetes mellitus. (Unpublished master’s thesis). University of Chester, United Kingdom 2013. Available from: https://core.ac.uk/download/pdf/20072895.pdf. Accessed 11 Dec 2019.
Shahid M, Mahar SA, Shaikh S, Shaikh ZU. Mobile phone intervention to improve diabetes care in rural areas of Pakistan: a randomized controlled trial. J Coll Physicians Surg Pak. 2015;25(3):166–71.
Suksomboon N, Poolsup N, Nge YL. Impact of phone call intervention on glycemic control in diabetes patients: a systematic review and meta-analysis of randomized, controlled trials. PLoS One. 2014;9(2):e89207.
Ahmed F, Asim-Bin-Zafar MR, Ghafoor E, Rehman RA, Uddin Q. Impact of 24-hour helpline service for people with diabetes. Pak J Med Sci. 2017;33(3):747–51.
Ahmedani MY, Alvi SF, Fawwad A, Basit A. Implementation of Ramadan-specific diabetes management recommendations: a multi-centered prospective study from Pakistan. J Diabetes Metab Disord. 2014;13(1):37.
Ahmad J, Pathan MF, Jaleel MA, Fathima FN, Raza SA, Khan AA. Diabetic emergencies including hypoglycemia during Ramadan. Ind J Endocrinol Metab. 2012;16(4):512.
Ramadan study group collaborators;
Prof. Hakim Ali Abro, Professor of medicine, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana-Sindh
Prof. Abdul Basit, Professor of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University Karachi-Sindh
Dr. Asher Fawwad, Associate Professor, Department of Biochemistry Baqai Medical University
Dr. Farhat Ullah Khan, Consultant Diabetologist, Sambros Hospital, Karachi-Sindh
Dr. ShabeenNaz Masood, Consultant Obstetrician & Gynecologist, Sobhraj Maternity Hospital, KMC, Karachi,
Dr. Qamar Masood, Associate Professor of Endocrinology, Agha Khan University Hospital Karachi-Pakistan
Dr. Zahid Miyan, Assistant Professor, Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi – Sindh
Dr.Syed Abbas Raza, Consultant Endocrinologist at National Hospital and Medical Centre, Lahore
Dr. Musarrat Riaz, Consultant Physician, Assistant Professor of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University Karachi-Sindh
Dr. Sobia Sabir, Assistant Professor, Department of Diabetes and Endocrinology, Lady Reading Hospital, Peshawar - Khyber Pakhtunkhwa
Dr. Muhammad Saif UlHaque, Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University Karachi-Sindh
Dr. Awn Bin Zafar, Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University Karachi-Sindh
Prof. Jamal Zafar, Professor of Medicine, Pakistan Institute of Medical Sciences, Islamabad – Punjab
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Ahmedani, M.Y., Siddique, M. & Ramadan study group collaborators. Assessing the awareness and care of people with diabetes related to Ramadan fasting; a-cross sectional study from Pakistan. J Diabetes Metab Disord 19, 29–36 (2020). https://doi.org/10.1007/s40200-019-00471-6