Endocrine Abstracts

Background and Aim: Besides its religious aspect, Ramadan Fasting (RF) represents a significant cultural affirmation practice for Muslim patients with diabetes. Despite the health risks related to this ritual, many Muslims with diabetes continue to fast against medical advice. This study aims to analyze the effect of RF contraindication on the self-esteem of Muslim patients with diabetes.

Methods: We conducted a cross-sectional study involving 25 Muslim patients with diabetes referred to the Department of endocrinology of Hedi Chaker University Hospital, Sfax, Tunisia, two months before Ramadan 2021. We stratified the fasting-related risk according to the 2021 IDF-DAR score. Rosenberg’s self-esteem scale (RSES) was administrated immediately after announcing the medical decision about the possibility of fasting.

Results: The mean age was 58.7±12.6 years, with a female predominance (78.3%). Hypertension (52.2%) and dyslipidemia (47.8%) were the leading comorbidities. The mean duration of the evolution of diabetes was 10.9±8.4 years, with an average A1C of 9.1±1.7%. The mean 2021 IDF-DAR score was 5.5±4 points. We stratified our patients into three risk categories:• Low-risk patients (34.8%) who were allowed to fast.• Moderate-risk patients (26.1%) who were discouraged from fasting.• High-risk patients (39.1%) with a strict medical prohibition to fast. The mean RSES was 30.7±3.4 points. Lower self-esteem scores were recorded in the high-risk category (77.8%) compared with the moderate (50%) and the low-risk groups (50%). Higher self-esteem rates were observed in patients with low risk (50%), unlike those with moderate (12.5%) and high (0.0%) fasting-related risk (P=0.08).

Discussion: The imposition of restrictions on certain community and cultural practices in response to medical considerations possesses the potential to exert a profound influence on the self-esteem and social integration of individuals grappling with diabetes. Recognizing the intricate interplay between health-related constraints and cultural identity underscores the imperative for healthcare providers to adeptly navigate the provision of culturally safe, patient-centered care. This nuanced approach ensures a holistic and sustainable health outcome for individuals navigating the intersection of medical considerations and cultural identity.

Reference: 1. Hazar, Narjes, et al. "Psychological Effects of Fasting on Patients Suffering from Diabetes Type 2." Iranian journal of diabetes and obesity 11.4 (2019): 200-205.