Managing Diabetes and Fasting During Ramadan: Practical Guidance for Health Care Practitioners
Tariq Chukir, MD
Assistant Professor of Medicine
Weill Cornell Medicine-Qatar
Endocrinology Consultant
Qatar Metabolic Institute (HMC) & Sidra Medicine
Type 2 diabetes is highly prevalent in the Middle East and North Africa. Fasting during the holy month of Ramadan is a spiritual practice observed by millions of Muslims worldwide. This observance is associated with spiritual and psychological wellbeing, motivating many individuals with type 2 diabetes to participate in fasting. However, certain nuances require careful attention when managing individuals with diabetes who wish to fast.
Fasting can lead to physiological changes, and the medications used to treat diabetes can increase the risk of complications, such as hypoglycaemia1. Therefore, a thorough assessment before Ramadan is crucial to evaluate the risks of these complications and to develop strategies to mitigate them. A useful tool that can be used in clinical practice to assess the risk of hypoglycemia is the IDF-DAR Fasting Risk Score2.
Link to score: https://www.mdcalc.com/calc/10522/international-diabetes-federation-diabetes-ramadan-alliance-idf-dar-fasting-risk-assessment
In addition to risk assessment, Ramadan-focused diabetes education should include guidance on maintaining a healthy, balanced diet, engaging in physical activity, monitoring for complications, and knowing when to break the fast. One of the key considerations for individuals living with diabetes who wish to fast is adjusting medication regimens to reduce the risk of complications. Monitoring blood sugar levels several times a day while fasting in individuals at risk of hypo or hyperglycemia is vital to diabetes management1.
In summary, there is no one-size-fits-all recommendation for individuals living with diabetes, as they represent a heterogeneous population with varying risks of complications. An individualized approach should be developed. Those at higher risk, including individuals with type 1 diabetes, elderly patients with comorbidities such as cardiovascular disease and chronic kidney disease, and pregnant women with diabetes, must receive evidence-based guidance from their healthcare providers2,3.
References
- Hassanein M, Afandi B, Yakoob Ahmedani M, et al. Diabetes and Ramadan: Practical guidelines 2021. Diabetes Res Clin Pract. 2022;185:109185.
- Mohammed N, Buckley A, Siddiqui M, et al. Validation of the new IDF-DAR risk assessment tool for Ramadan fasting in patients with diabetes. Diabetes Metab Syndr. 2023;17(4):102754.
- Ibrahim M, Davies MJ, Ahmad E, et al. Recommendations for management of diabetes during Ramadan: update 2020, applying the principles of the ADA/EASD consensus. BMJ Open Diabetes Res Care. 2020;8(1):e001248.