Endocrine Abstracts

Background: Fasting during Ramadan is an obligatory duty for all healthy adult Muslims. However, a lot of type 2 diabetic Muslim patients insist on fasting whatever their condition. There are several potential physiological benefits from fasting, but the prolonged fasting hours during summer provides many questions about safety and efficacy of different insulin regimens for treatment of type 2 diabetic patients during Ramadan. So we aimed in this study is to assess safety and efficacy of different types and different strategies of insulin use in the treatment of type 2 diabetic patients who insist to fast during Ramadan 1437 (Hijri) in Fayoum Governorate.

Patients and methods: This study was conducted on 337 T2DM patients. divided into 3 groups: groups G1 - patients using basal oral regimen, and G2 using premixed insulin regimen and G3 patients on a basal-bolus regimen. For all participants’ structured educational sessions, history and clinical examination including blood pressure measurement, waist circumference and BMI, blood glucose, HbA1c, liver, kidney functions and lipid profile before and after Ramadan fast were done. During Ramadan all participants were asked to record readings for the FBS at noon & at 6 pm and a postprandial reading 1–2 hours after breakfast on the following days (2,14,28) and also to record any day that fast was broken with the cause for this.

Results: Hypoglycemic events whether documented or symptomatic were more prevalent (44%&52% respectively) among patients on the basal-bolus regimen with the number of episodes of documented hypoglycemia per patient were higher in this regimen (1.9±0.9) compared to the other two regimens and this difference was statistically significant (P=0.046). A statistically highly significant reduction in HbA1c had occurred among patients using premixed insulin ± oral antidiabetic medications (P<0.0001), however, patients on this regimen had the highest prevalence of non-fasting days (44.6%) due to DM.

Conclusion and recommendations: There were comparable results regarding safety and efficacy of the three studied regimens in the treatment of type 2 diabetic during Ramadan. No regimen proved to be superior. Patient education before Ramadan fast is a mandatory step in management.