Introduction: Fasting during Ramadan is an obligatory practice for adult Muslims. Although exemptions exist in certain conditions,including diabetes, the majority of diabetic patients fast despite this concession with the risk of complications mainly hypoglycemic accidents. The aim of this study is to establish the relationship between hypoglycemic accidents and drug treatment, therapeutic education, clinical and biological characteristics of tunisian diabetic patients during Ramadan 2019.
Methods: A prospective descriptive observational study including 85 diabetic patients followed at the National Nutrition Institute of Tunis. Clinical and biological data are noted before four to eight weeks and after the month of Ramadan 2019.
Results: The mean age was 55.8 ± 12.7 years. Most of the patients had type 2 diabetes (97.7%). A slight female predominance was noted (52.3%). The average duration of diabetes was 10.6 ± 6.6 years. Two thirds of the patients are classified as high or very high risk for fasting. Only 30% of the patients were allowed to fast. Treatment with oral antidiabetics, insulin, or a combination of the two was prescribed in 50%, 12.8% and 37.2% of cases. The average of HB1AC before and after Ramadan was 8 ± 1.2%, and 8.6 ± 1.35% respectively. Severe hyperglycaemia (> 3 g/l) was reported in 5.8% of cases. Hypoglycemic accidents were noted in 18.6% of patients, 14.9% of whom were on insulin (P = 0.026), either alone or in combination with oral antidiabetics, 16.27% were at high or very high risk (P = 0.128), 87.5% with type 2 diabetics (P = 0.03) and 13.95% uneducated for fasting (P = 0.82). Most of patients fasted all month (72.1%). Hypoglycemic accidents were the main cause of breaking fasting (62% of cases, P < 0.01). Half of the patients did not glycemic monitoring during the fasting but without significant impact on the incidence of hypoglycaemia. In addition, there were no hospitalized patients during this month.
Conclusions: The consequences of fasting in diabetic patients were mainly hypoglycaemia. Insulin therapy was a predictor of hypoglycemia during Ramadan. Identification of individuals who required Ramadan specific education is essentiel to prevent these complications.
05 Sep 2020 - 09 Sep 2020