Diabetic Patients and Ramadan
AbstractMore than 50 million people with diabetes mellitus fast during Ramadan, a religious obligation for all healthy adult Muslims. Fasting leads to several physiological changes in the body and these may result in acute complications in persons with uncontrolled diabetes such as hyperglycemia, hypoglycemia, diabetic ketoacidosis, dehydration and thrombosis. Evidence from existing literature guides the physicians in their assessment of Muslim patients with diabetes who wish to fast. Assessment should include risk stratification based on existing control of diabetes and its chronic complications. In the light of this assessment medical recommendation is given which includes dose modification of oral medication and insulin, dietary advice and structured patient education.
Brian JG, Mehtab SK. The Future Global Muslim Population. Projections for 2010-2030. [Internet] ©2011. Washington, DC, Pew Research Center. Available from: The Future of the Global Muslim Population - Pew Forum on Religion & Public Life. Accessed October 9, 2012.
Al-Arouj M, Assaad-Khalil S, Buse J, et al. Recommendations for management of diabetes during Ramadan. Update 2010. Diabetes Care 2010;33:1895-902.
Benaji B, Mounib N, Roky R, et al. Diabetes and Ramadan: Review of the literature. Diabetes Res Clin Pract 2006; 73(2):117-25.
Hui E, Bravis V, Hassanein M, et al. Management of people with diabetes wanting to fast during Ramadan. BMJ 2010; 340:3053.
Jaleel MA, Raza SA, Fathima FN, Jaleel BNF. Ramadan and diabetes: As-Saum (The fasting). Indian Journal of Endocrinology and Metabolism. October-December, 2011; 15(4).
Salti I, Be’nard E, Detournay B, et al. Results of the Epidemiology of Diabetes and Ramadan 1422⁄2001 (EPIDIAR) study. Diabetes Care 2004; 27:2306-11.
Rashed H. The fast of Ramadan: No problem for the well; the sick should avoid fasting, BMJ 1992; 304:521–522.
Khatib FA, Shafagoj YA. Metabolic alterations as a result of Ramadan fasting in non-insulin-dependent diabetes mellitus patients in relation to food intake, Saudi Med J 2004;25:1858–1863.
Nagati, K.; Kammoun, H.; Abid, A.; Blouza, S.; Jamoussi, H.; Atallah, M.et al. Diabetes and fasting during Ramadan: A multicentric Tunisian study. Médecine et Nutrition 2000 ;36 (2):90-95.
Sadr S, Afshar M, Sarboluki S. Effect of fasting on glucose, lipids, body weight and blood pressure among non-Insulin dependent diabetes mellitus. KAUMS Journal (FEYZ). 1998; 2 (2) :71-76
Sari R, Balci MK, Akbas SH, Avci B, The effects of diet, sulfonylurea and repaglinide therapy on clinical and metabolic parameters in type 2 diabetic patients during Ramadan, Endocr Res 2004;30(2):169–177.
Athar S, Habib M. Management of stable typical 2 diabetes mellitus (NIDDM) during Islamic fasting in Ramadan, in: The First International Congress on Health and Ramadan Casablanca, Morocco, 1994:203–212.
Yarahmadi SH, Larijani B, Bastanhagh MH et al., Metabolic and clinical effects of Ramadan fasting in patients with type II diabetes, JCPSP 2003;13:329–332.
Loke SC, Rahim KF, Kanesvaran R, Wong TW. A prospective cohort study on the effect of various risk factors on hypoglycemia in diabetes who fast during Ramadan. Med J Malaysia 2010; 65:3–6.
Ahmad J, Pathan F, Jaleel MA. Diabetic emergencies including hypoglycemia during Ramadan. IJEM 2012; 16(4):512-515.
Kadiki OA, Moawad SE, Khan ZA, Reddy MR, Marzoung AA. Diabetes mellitus and Ramadan. Garyounis Med J 1989; 12:32–4.
Azad K, Mohsin F, Zargar AH et al. Fasting guidelines for diabetic children and adolescents. Indian J Endocrinol Metab 2012; 16(4):516-8.
Rafik E, Mohammad E, Hanan E. Incidence of Diabetic Ketoacidosis during Ramadan Fasting in Benghazi-Libya. Oman Med J 2009; 24:99–102.
Al-Arouj M, Bouguerra R, Buse J et al. Recommendations for the management of diabetes during Ramadan. Diabetes Care 2005; 28:2305–11.
Uysal AR, Erdog˘an MF, Sahin G, Kamel N, Erdog˘an G. Clinical and metabolic effects of fasting in 41 type 2 diabetic patients during Ramadan (Letter). Diabetes Care 1998; 21:2033–2034.
Katibi IA, Akande AA, Bojuwoye BJ, Okesina AB. Blood sugar control among fasting Muslims with type 2 diabetes mellitus in Ilorin. Niger J Med 2001; 10:132–13.
Ahmedani MY, Haque MS, Basit A, Fawwad A, Alvi SFD. Ramadan Prospective Diabetes Study: The role of drug dosage and timing alteration, active glucose monitoring and patient education. Diabetic Medicine 2012; 29(6):709-715.
Hitman GA. Fasting, Ramadan and Diabetes. Diabetes Med 2012;29:695
Bravis V, Hui E, Salih S, Mehar S, Hassanein M, Devendra D. Ramadan education and awareness in diabetes programme for Muslims with type 2 diabetes who fast during Ramadan. Diabetes Med 2010; 27:327-31.
Mojaddidi M, Hassanein M, Malik R. Ramadan and diabetes: Evidence-based guidelines. Prescriber September 2006; 38-41.
Hui, E. and Devendra, D. Diabetes and fasting during Ramadan. Diabetes Metab. Res. Rev., 2010;26:606–610.
Bashir MI, Pathan F, Raza SA et al. Role of oral hypoglycemic agents in the management of type 2 diabetes mellitus during Ramadan. Indian Journal of Endocrinology and Metabolism. July-August, 2012; 16(4).
Schernthaner G, Grimaldi A, Di Mario U et al. GUIDE study: Double-blind comparison of once-daily gliclazide MR and glimepiride in type 2 diabetic patients. Eur J Clin Invest 2004; 34:535–542.
Rendell M. The role of sulphonylureas in the management of type 2 diabetes mellitus. Drugs 2004; 64:1339–58.
Pan C, Yang W, Barona JP et al. 17 Comparison of vildagliptin and acarbose monotherapy in patients with type 2 diabetes: a 24-week, double-blind, randomized trial. Diabetes Med 2008; 25:435-41.
Drucker DJ, Sherman SI, Gorelick FS, Bergenstal RM, Sherwin RS, Buse JB. Incretin-based therapies for the treatment of type 2 diabetes: Evaluation of the risks and benefits. Diabetes Care 2010; 33:428–433.
Al-Arouj M, Bouguerra R, Buse J et al. American Diabetes Association recommendations for management of diabetes during Ramadan. Diabetes Care 2005;28:2305-11.
Pathan F, Sahay RK, Zargar AH et al. South Asian Consensus Guideline: Use of insulin in diabetes during Ramadan. Indian Journal of Endocrinology and Metabolism. July-August 2012; 16(4).
Mattoo V, Milicevic Z, Malone JK, Ramadan Study Group. A comparison of insulin lispro Mix25 and human insulin 30/70 in the treatment of type 2 diabetes during Ramadan. Diabetes Res Clin Pract 2003;59:137–143.
How to Cite
Journal of the ASEAN Federation of Endocrine Societies is licensed under a Creative Commons Attribution-NonCommercial 4.0 International. (full license at this link: http://creativecommons.org/licenses/by-nc/3.0/legalcode).
To obtain permission to translate/reproduce or download articles or use images FOR COMMERCIAL REUSE/BUSINESS PURPOSES from the Journal of the ASEAN Federation of Endocrine Societies, kindly fill in the Permission Request for Use of Copyrighted Material and return as PDF file to email@example.com or firstname.lastname@example.org.
A written agreement shall be emailed to the requester should permission be granted.