1. HbA1c before Ramadan (%)
GLYCAEMIC PROFILES AMONG MUSLIM PATIENTS WITH DIABETES DURING RAMADAN FASTING
Abdullah SB1, Zainudin SB2, Chan YL1, Soh AWE2
1Department of Nursing, Singapore General Hospital
2Department of Endocrinology, Singapore General Hospital
Introduction
Ramadan is a month in the Islam calendar which all healthy adult Muslims are required to fast from sunrise to sunset.
During this time, they have to abstain from food, water, beverages, smoking, oral drugs and sexual intercourse1.
In the Epidemiology of Diabetes and Ramadan (EPIDAR) study, 43% of people with type 1 diabetes mellitus (DM) and 86% of people with type 2 DM observed the fast during Ramadan2.
People with DM who fast during the month of Ramadan are at increased risk of acute complications, such as hypoglycaemia, hyperglycaemia, diabetic ketoacidosis, dehydration, and thrombosis.
Most of these complications occur as a result of decreased food and fluid intake3, glucose-lowering medications, and lack of regular blood glucose monitoring.
Aim
To examine the glycaemic profiles of Muslim patients with DM who underwent fasting during the month of Ramadan.
Methods
A prospective, observational study evaluating the glycaemic profiles of Muslim patients with type 2 DM who fasted during Ramadan in July-August 2012.
All the patients were advised by an endocrinologist on adjustments to their glucose-lowering medications during Ramadan fasting.
Patients were asked to record capillary blood glucose (CBG) readings using a glucometer:
 2 sets of readings in the week (0) before the start of Ramadan –
2 fasting and 2 post-meal readings
 3 sets of readings each week (1-4) during Ramadan - at least 1
fasting reading per set
 2 sets of readings in the week (5) after the end of Ramadan - 2
fasting and 2 post-meal readings 
Frequency of hypoglycemia was also examined.
HbA1c was performed before and after Ramadan.
Baseline Characteristics
 A total of 10 patients were recruited but only 7 patients completed the study – 6 female and 1 male.
 Mean age was 59.7 years (range, 42–70).
 Duration of DM ranged from 9 months to 24 years.
 Five patients were on insulin therapy and 4 were known to have diabetes-related microvascular complications.
Results
 Mean HbA1c before Ramadan: 9.0 ± 1.3%.
 Mean HbA1c after Ramadan: 8.6 ± 2.0%.
 Five out of 7 patients* had reduction in their HbA1c levels after Ramadan with a mean reduction of 1.3 ± 0.8%.
 Two patients (C and G) recorded hypoglycaemia (CBG <4 mmol/L) during fasting – lowest CBG 3.4 mmol/L.
Table 1. HbA1c levels of the patients before and after Ramadan.
Graph 1. Mean weekly capillary blood glucose of the patients.
Conclusion
 Although the rate of documented hypoglycaemia was low in this study, 70% of the patients had a reduction of their HbA1c after Ramadan.
 This underlies the importance of dose adjustment of glucose-lowering medications and regular blood glucose monitoring for Muslim patients with DM to avoid the occurrence of hypoglycaemia during Ramadan fasting.
Patient
HbA1c before Ramadan (%)
HbA1c after Ramadan (%) A
8.1
10.3 B
10.1
11.8 C*
10.4
8.2 D*
9.4
7.3 E*
8.9 F*
6.5
5.5 G*
9.5
9.0
References
1. Bravis V, Hui E, Salih S, et al. Ramadan education and awareness in diabetes programme for Muslims with Type 2 diabetes who fast during Ramadan. Diabet Med 2012; 27:
2. Salthi I, Bernard E, Detournay B, et al. A 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 (EPIDAR) study. Diabetes Care 2004; 27:
3. Al-Arouj M, Radhia B, John B, et al. Recommendations for management of diabetes during Ramadan. Diabetes Care 2005; 28: