Diabetic hypoglycaemia during Ramadan fasting: A trans-national observational real-world study.

Abstract

OBJECTIVES\nTo describe the risk of hypoglycaemia during Ramadan and determine its risk factors, and the impact of hypoglycaemia on patients behaviour.\n\n\nMETHODS\nA cross-sectional multi-country observational study, with data captured within 6\u202fweeks after Ramadan 2015. Patients and disease characteristics and its management, the risk of hypoglycaemia and patients response to hypoglycaemia were recorded.\n\n\nRESULTS\nA cohort of 1759 patients; majority with type 2 diabetes mellitus from North Africa, Arabian Gulf, Saudi Arabia, and the Indian subcontinent. Hypoglycaemia was reported by 290 patients (16.8%); particularly affecting type 1 diabetes patients and in insulin-treated patients in general. Age was significantly younger in the hypoglycaemia group (P\u202f<\u202f0.001). The commonest responses were reducing the dose or frequency of medications (42%), attending primary care providers (24.5%) or increasing monitoring (20.7%). Fasting was interrupted by 67% only of those who experienced hypoglycaemia and recourse to emergency services was pursued by less than a quarter of patients with hypoglycaemia. The country-wise analysis of the rates of hypoglycaemia was greatest in Egypt (51.3%) and lowest in Pakistan (3.5%).\n\n\nCONCLUSIONS\nHypoglycaemia is a significant complication of fasting during Ramadan. It may be predicted by type of diabetes, and use of insulin. Patients responses are varied and call for more formal pre-Ramadan education.