Endocrine Abstracts

Background: With increasing ethnic diversity in the Western World, it is important to establish the safety of religious practices such as fasting during Ramadan. There is limited information about severity and outcome of diabetes-related ketoacidosis (DKA) during Ramadan outside Middle East.

Objective: We studied differences in severity, DKA-related complications and outcomes of DKA before (Shaban), during (Ramadan) and after Ramadan (Shawwal).

Methods: All DKA events in Shaban, Ramadan and Shawwal from 2014 to 2022 at various tertiary and regional hospitals in the United Kingdom participating in the DEKODE (Digital Evaluation of Ketosis and Other Diabetes-related Emergencies) were included in this study. The diagnosis of DKA was defined as per the national guidelines. DKA parameters at presentation and during management, were investigated according to timing of DKA episode, diabetes type, and ethnicity. Data were analysed using Stata/SE V.16.1 for Mac. Data was found to be non-normally distributed using Shapiro-Wilk tests. Skewed data were presented as median and IQR. Discrete data were summarised as number (%) and statistical comparisons were made using chi-squared tests. These parameters were further investigated in subgroup analyses according to timing of DKA episode (before, during, and after the month of Ramadan), diabetes classification (type 1 and type 2), and ethnicity (Black, White, Asian, Mixed, Other).

Results: 512 DKA episodes were identified for this study. Excluding urea and serum osmolality, there were no differences at presentation of DKA during Ramadan compared to Shaban and Shawwal. There was no significant difference in the outcome of DKA as measured by DKA duration (Shaban vs Ramadan vs Shawwal: 14.3 (8.9-24.4) vs 15.1 (9.5-22.8) vs 15.3 (9.6-23.2) hours, P=0.800) and length of stay (Shaban vs Ramadan vs Shawwal: 3.6 (1.9-8.8) vs 4.1 (2.1-8) vs 4.1 (2.1-9.7), P=0.670). Also, there was no significant difference in the number of hypoglycaemias, hypokalemia and hyperkalemia associated with DKA management during Shaban, Ramadan and Shawwal. Overall, there were no year-based differences between the years of 2014 to 2022. People with T1DM had higher acidosis and more hyperglycaemic events during Shawwal compared to T2DM. Across ethnicity, South Asians had more severe DKA in Ramadan compared to Shaban and Shawwal.

Conclusion: In the largest of its kind study in the Western world, we demonstrate no difference in DKA frequency during Ramadan. The increased severity of DKA during Shawwal, particularly in people with T1DM, suggests future guidelines should focus on the period following Ramadan to mitigate risk.