Zainudin S 1, Ang DY 2, Goh SY 1, Soh AW 1. Department of Endocrinology, Singapore General Hospital, Singapore 1 ; Yong Loo Lin, School of Medicine, National University of Singapore, Singapore 2 - Background  The Epidemiology of Diabetes and Ramadan (EPIDIAR) study demonstrated that many Muslim diabetic patients fast during Ramadan with increased incidence of hypoglycemic episodes 1.  Previous studies had shown general lack of knowledge of public in certain aspects of diabetes.  The Ramadan Education and Awareness in Diabetes (READ) program for Muslims with type 2 diabetes mellitus (DM) had shown significantly decreased hypoglycemic episodes and weight gain during fasting month for patients who had undergone a structured education program for management of diabetes during fasting 2. Aim  To evaluate patients’ knowledge of safe practices and management of DM during the fasting month of Ramadan. Methods  Muslim patients with DM attending outpatient appointments at Diabetes Centre in Singapore General Hospital from June 2011 to August 2011 were enrolled.  Data including demographics, type, duration and treatment of DM, and knowledge of DM management during Ramadan was collected prospectively via a self- administered questionnaire.  Data on patients’ glycemic control was also collected.  Patients were assessed on knowledge of risk factors due to changes in Ramadan, risk of complications and safe practices during fasting, and DM management during the previous Ramadan. Results  Baseline characteristics of the study population are as shown in Table 1.  Results of the questionnaire are reflected in Table 2. Knowledge of Safe Practices and Diabetes Management in the Fasting Month of Ramadan in Muslim Patients with Diabetes Mellitus Baseline Characteristics Study Population Number of subjects92 Mean age (years) 53.9 ± 13.1 Ethnic distribution (%) Malays91.7 Indians8.3 Level of Education (%) Secondary school and above71 Less than secondary school29 Mean duration of DM (years) 8.8 ± 5.1 Glucose-lowering therapy (%) Oral glucose-lowering drugs30 Insulin therapy34.5 Combined therapy22.6 Mean HbA1c pre-Ramadan (%) 8.7 ± 1.8 Knowledge Variable Study Population (%) Overall knowledge on DM58.6 Scoring less than 50%21.4 Management during previous Ramadan Discussed with primary physician66.7 Self-reported hypoglycemic episodes42.9 Patients that continued to fast5.6 Self-monitoring of blood glucose35 Questions with Answers Options of Yes, No or Do not know Knowledge of Risk Factors During Ramadan Blood sugar remains low throughout the day. Dietary control is not necessary to keep blood sugar level normal. Activity level increases during Ramadan. Medications for diabetes and insulin should be omitted. Checking of blood sugar is not necessary during Ramadan. Knowledge of Symptoms and Complications of Fasting in Diabetes Symptoms of high blood sugar level include : Constantly feeling thirsty, frequent urination, blurred vision, slow healing of cuts and wounds, tiredness and weakness, weight loss despite normal appetite. Symptoms of low blood sugar level include : Sweatiness, giddiness and feeling faint, heart beating very fast, confused or talking inappropriately. Fasting results in good control of blood sugar level during Ramadan. Fasting in the elderly with high blood pressure and high cholesterol may result in dehydration and blockage of blood vessels. Knowledge of Safe Practices and Management of Diabetes During Ramadan Before fasting, diabetes patients should consult their doctor about their suitability for fasting. Before fasting, diabetes patients should consult their doctor for advice on diet and blood sugar monitoring. Diabetes patients should ensure adequate fluid intake. Diabetes patients should eat more starchy food during meals. Fasting can be continued when having high fever and/or vomiting. It is not necessary to break fast if diabetes patients develop symptoms of low blood sugar during fasting. Checking of blood sugar at home does not constitute breaking fast. Diabetes patients do not need to check their sugar level during the month of Ramadan. Diabetes patients should carry sweets with them at all times. Diabetes patients should not skip Sehri (early morning meal) and Iftar (break fast). Pregnant diabetes patients are strongly advised not to fast. Past Management of Diabetes During Ramadan Did your doctor advise you how to manage your diabetes/adjust your medications when you fast during Ramadan? Did you experience low sugar episodes during Ramadan last year? If you had low sugar episodes, did you break fast to correct the low blood sugar level? Did you check your blood sugar using a glucose meter during Ramadan last year? Table 1.Baseline Characteristics of Study Subjects Table 2. Knowledge Variables and Scores Table 3. Sample of Questions in the Questionnaire Conclusions  Knowledge of safe practices and DM management during Ramadan is inadequate with a high rate of complications despite high literacy level in our study population.  A structured education programme may be useful to reduce complications during fasting for Muslim patients with DM during Ramadan. References 1. Salti I, Bénard E, Detournay B et al. Results of the Epidemiology of Diabetes and Ramadan 1422⁄2001 (EPIDIAR) study. Diabetes Care 2004;27: Bravis V, Hui E, Salih S et al. Ramadan 9 education and awareness in diabetes programme for Muslims with type 2 diabetes who fast during Ramadan. Diabetes Medicine 2010;27: Al-Arouj M, Assaad-Khalil S, Buse J et al. Recommendations for Management of Diabetes During Ramadan Update Diabetes Care 2010; 33,