Ramadan and good glycemic control

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Ramadan and good glycemic control

• Is it possible ?

N.NERI, M.E.CHAUVEAU, M.LUCIANI, M.A.DOMIN,
C.BERNE, J.Y.BERTRAND, M.LEVY Diabetology
Department, Max Fourestier Hospital Nanterre,
FRANCE
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Diabetes and Ramadan

• Despite
• clear religious exemption from fasting for
  patients with serious disease
• International consensus (Hassan II Foundation for
  scientific and medical research on Ramadan,
  Ramadan Advisory Board)
• Many muslim diabetic patients choose to
  participate to the annual fast of Ramadan
• Inducing a possible deterioration of glycemic
  control

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• In order to confirm this deterioration, we
  conducted a first retrospective study in 2002
• in 46 consecutive muslim type 2 diabetic
  patients
• fasting or non fasting
• comparing HbA1c before (within 6 months) and
  after (1.5 month after the end) the Ramadan fast.
• HbA1c before 7,7 1,3
• HbA1c after 8,7 1,1

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A multifaceted interventionto improve quality of
care

• For health care providers
• In the department,
• We give general information on lifestyle
  modifications during the period
• We built a Religious-based argumentation in
  order to explain fast exemption and diet control
• We write protocols to modify treatment during the
  Ramadan, including use of insulin analogs
• In  Réseau Diabète 92 , a network devoted to
  type 2 diabetes management, we teach all members
  about Ramadan management

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• For patients and their family
• Systematic explanation by the physician on the
  importance not stopping treatments
• Personalized advice about changes in treatment
  (physician, nurse) and diet (dietetician)
• Importance of family help in order not to exclude
  patients during the fast and meals after.
• Afterwards, this intervention was prospectively
  evaluated.

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Patients and methods

• In 2003 and 2004,
• During the 45 days after the end of the month of
  Ramadan, we included
• All muslim type 2 diabetics
• Usually followed in the Department
• Exclusion criteria
• Pregnancy and gestational diabetes
• Major treatment change or hospitalization in the
  6 months before the beginning of Ramadan
• No visit in the 6 months before the beginning of
  Ramadan

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• The physician collects detailled information on
• Lifestyle during Ramadan (fast, diet)
• Diabetes management (monitoring blood glucose,
  treatment changes)
• Acute events (hypoglycemias, and severe
  hyperglycemias)
• Previous information about diabetes management
  during Ramadan
• Weight and HbA1c (DCA2000)
• Actual
• During the last visit in the Department (within 6
  months)

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Baseline carateristics of patients
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Baseline carateristics of patients
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Baseline carateristics of patients
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Baseline carateristics of patients
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Baseline caracteristics of patients (1)
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Baseline caracteristics of patients (2)
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• Previous information about diabetes management
  during Ramadan
• In 2003, 21 patients (46)
• In 2004, 32 patients (56)
• Acute events
• In 2003
• Stop fasting 2 patients (1 for benign
  hypoglycemia)
• In 2004
• Stop fasting 3 patients (1 for acute severe
  hyperglycemia and 1 for benign hypoglycemia)

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Self Monitoring Blood glucose in patients
completing fast

• Patients maintaining or increasing SMBG
• In 2003  26 (out of 35 patients) 74
• In 2004  22 (out of 31 patients) 71
• 58 of these patients performed SMBG during the
  fast

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Control of diet in patients completing fast

• In 2003, 22 patients (out of 35) ie 63
• In 2004, 17 patients (out of 36) ie 47
• spontaneously reported to follow diet counseling
  on
• Eating dates when breaking fast
• cakes
• carbohydrates
• Fat

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Treatment modification in patients completing fast
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Evolution of weight (Kg)
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Evolution of weight (Kg)
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Evolution of HbA1c ()
? All patients having a visit in the Department
during the same period
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Evolution of HbA1c ()
? All patients having a visit in the Department
during the same period
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Conclusion

• Observance of Ramadan and possible fast during
  the month for type 2 diabetic patients is
  possible
• without deterioration of glycemic control
• Without major metabolic complications
• If and only if
• information is given to patient in order that he
  decide himself if fast is possible or not
• The family is involved
• The patient agrees with a transient treatment
  modification (diet, OAD, insulin) and to maintain
  SMBG

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Versets du Coran utilisés

• Sourate 2 verset 183 
•  Le jeûne du Ramadan est un des 5 piliers de
  lIslam, cependant, quand le jeûne peut altérer
  de manière significative la santé du jeûneur ou
  quand la personne est malade, lIslam lexempte
  du jeûne .
• Sourate 2 verset 185 
•  Allah cherche à vous faciliter
  laccomplissement de la règle, il ne cherche pas
  à vous le rendre difficile 
• Sourate 7 verset 31, valable tout lannée pour
  les diabétiques et non diabétiques 
•  Ô enfants d'Adam, dans chaque lieu de Salat
  portez votre parure (vos habits). Et mangez et
  buvez et ne commettez pas d'excès, car Il
  Allah n'aime pas ceux qui commettent des excès
  ..