Download Diabetes and Ramadan: Practical Guidelines International Diabetes

Dr.M.sanjari
95/02/27
Is fasting during Ramadan associated with a
significant risk?
 What are the criteria that predispose patients
with diabetes to increased risk during fasting?
 What is the most appropriate oral antidiabetic drug(s) for patients with type 2
diabetes (T2DM) who fast during Ramadan?
 What is the most appropriate type and
regimen of insulin for patients with diabetes
who fast during Ramadan?

Prevalence rates in many countries
in the Middle East and North
Africa are well above the average
global prevalence of 8.8%, and the
region as a whole has the second
highest comparative prevalence of
diabetes (10.7%).
 Is
increasing
 642 million people
 Marked in Muslim-majority
countries.
 Estimates :148 million Muslims
with diabetes worldwide.
 Favourable
effects on lipid profile
(healthy)
 Favourable and
unfavourableeffects on lipid
profile (Diabetics)
 Weight remained unchanged
Category 1:very high risk
One or more of the following:
 Severe hypoglycaemia (3 months)
 DKA (3 months)
 Hyperosmolar hyperglycaemic coma (3
months)
 History of recurrent hypoglycaemia (3
months)
 History of hypoglycaemia unawareness
 Category
1:very high risk(continue)
Poorly controlled T1DM
 Acute illness
 Pregnancy in diabetes, or GDM
(insulin,SU)
 Chronic dialysis or CKD stage 4 & 5
 Advanced macrovascular complications
 Old age with ill health
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Category 2: high risk
One or more of the following:
T2DM with sustained poor glycaemic control*
Well-controlled T1DM
Well-controlled T2DM on MDI or mixed
insulin
Pregnant T2DM or GDM (diet or metformin)
CKD stage 3
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Category 2: high risk (continue)
Stable macrovascular complications
Patients with comorbid conditions that
present additional risk factors
People with diabetes performing intense
physical labour(hard work)
Treatment with drugs that may affect
cognitive function
Category 3:moderate/low risk
 Well-controlled T2DM on:
 – Lifestyle therapy
 – Metformin
 – Acarbose
 – Thiazolidinediones
 – Second-generation SUs
 – Incretin-based therapy
 – SGLT2 inhibitors
 – Basal insulin
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Receive structured
education
Be followed by a
qualified diabetes team
Check their blood
glucose regularly (SMBG)
Adjust medication dose
as per recommendations

Be prepared to break
the fast in case of
hypo- hyperglycaemia
Be prepared to stop the
fast in case of frequent
hypo/hyperglycaemia
or worsening of other
related medical
condition
 Patients
who fast should:
 Receive structured education
 Check their blood glucose regularly
(SMBG)
 Adjust medication dose as per
recommendations
Type 1 diabetes: Advised not to fast
 The elderly: Many older people have
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enjoyed fasting during Ramadan for many
years and they should not be categorized as
high risk based on a specific age but rather
on health status and social circumstances
Pregnant women :Advised not to fast
 Acarbose:
No RCTs ,NO dose modification
 Thiazolidinediones:
One study, NO dose modification
 Repaglinide and nateglinide:
May be REDUCED or
REDISTRIBUTED to two doses

Sodium-glucose co-transporter-2 (SGLT2)
inhibitors: Use with Caution , NO DOSE
ADJUSTMENT , taken with iftar.
Dipeptidyl peptidase-4 (DPP-4) inhibitors:
NOT REQUIRE TREATMENT MODIFICATIONS

 Glucagon-like
peptide-1 receptor
agonists (GLP-1 RAs) :
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liraglutide is safe
DOSE-TITRATED prior to Ramadan (6 weeks
before)
NO FURTHER TREATMENT MODIFICATIONS
are required
History of recurrent hypoglycaemia
 Hypoglycaemia unawareness
 Poor diabetes control
 Brittle diabetes
 Non-compliance with medical
treatment
 Patients who are ’unwilling‘ or
’unable‘ to monitor and manage their
blood glucose levels.

The decision by an individual with
T1DM to fast during Ramadan must be
respected. There is some evidence to
suggest that, as long as they are
otherwise stable and healthy, they can
do so safely. However, strict medical
supervision and focused education on
how to control their glycaemic levels
is essential.
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A pre-Ramadan assessment ,patient-specific
treatment plan.
With the correct advice and support from
HCPs most people with T2DM can fast safely
during Ramadan.
Patients taking metformin, short-acting
insulin secretagogues, SUs or insulin
will need to make adjustments to dose and
or timings to reduce the risk of
hypoglycaemia while maintaining good
glycaemic control.
Newer OADs including incretin-based
therapies are associated with a lower risk of
hypoglycaemia and may be preferable for use
during Ramadan.
 SGLT2 inhibitors are probably safe but should
be used with caution in some patients.
 very high/high risk (T1DM and pregnant
women) close medical supervision and
focused
 post-Ramadan follow-up consultation
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