Diabetes And Ramadan: Medical Community United In Raising Awareness On Fasting Safely

Medical experts have met and reiterated their call in intensifying education for both healthcare professionals and patients with diabetes about fasting during the Holy Month of Ramadan which happens this summer. During the 3rd Diabetes and Ramadan International Alliance Conference which happened over the weekend at Sheikh Mohammed bin Rashid Academic Medical Center, experts led by Sir Michael Hirst, President of the International Diabetes Federation (IDF), Dr. Abdulrazzak Ali Al Madani, President of the Gulf Group for the Study of Diabetes (GGSD) and President of Emirates Diabetes Society (EDS) and Dr. Mohamed Hassanein, Chair of Diabetes and Ramadan (DAR) International Alliance and consultant endocrinologist at Dubai Hospital, discussed latest developments in diabetes care and best practices in educating diabetes patients who will fast longer this Ramadan, reaching almost 15 hours. Medical experts also extended the call to educate people without diabetes but live with families affected by the disease.

The IDF Atlas Sixth Edition confirms almost 37 million people in the MENA region alone have diabetes with an estimated cost of US$458 per person for treatment in 2014. Moreover the disease is evolving so rapidly, necessitating a dynamic health care environment and a highly skilled diabetes medical community who could face the growing challenges to control it.

At the moment, there are nearly 400 million people with diabetes and this is predicted to rise to nearly 600 million in 20 years time. And of these extra 200 million cases, 4/5 of them will be in the developing world and the majority of them will be of the working age. So diabetes is just no longer a health issue, its also a development issue, said Sir Michael Hirst, President of IDF on diabetes prevalence globally. He explained further why diabetes is becoming a more urgent concern: It is likely in 20 years time that the number of people with diabetes or at serious risk of developing it will have exceeded one billion one person in eight on the planet will have diabetes. What is absolutely essential is that care should be optimized for the people with diabetes. One half of them as yet havent been diagnosed so they are not receiving care. For those who have been diagnosed many of them have no access to the right care. Therefore, empowering our people with diabetes to be able to manage their own condition and educating the professionals who care for them is important.

Despite the prevalence of diabetes in alarming levels especially in the Middle East, people with diabetes are expected to fast during the Holy Month possibly with some of them having minimal consultation with their doctors. Medical experts urge patients to plan ahead of Ramadan before fasting.

The lack of food and water during the day, along with a heavy evening meal, can create serious health issues for people living with diabetes, as they are faced with major disruptions to their diet and daily routines, which may lead to complications. Studies have shown that there is an increased risk of severe hypoglyceamia for individuals with Type 1 or Type 2 diabetes, especially for those who change the dosages of their oral medications or insulin1, 2.

For all the patients who have diabetes and are planning to fast in Ramadan, they have to start preparing themselves at least three or four months before. Although the whole year they should look to control their blood sugar, during this period they should be extra careful. They should keep their sugar well-balanced be careful not to reach too high or low levels of blood sugar. So that in Ramadan, they are ready for fasting, said Dr. Abdulrazzaq Ali Al Madani, President of GGSD and President of EDS, who is one of the key resource persons in the conference.

Dr. Al Madani added that it is very important for people with diabetes fasting during the Holy Month to check their blood sugar levels three to five times a day to ensure that they are not at a risk. An agreed limit has to be set between the patient and the doctor which must be observed. He also cautioned diabetes patients not to overeat when breaking their fast and to drink plenty of water between sunset and dawn to minimize the risk of dehydration.

The call was amplified during the 3rd DAR International Alliance Conference which discussed evidence-based findings as well as guidelines and tools to manage the disease among different categories of people with diabetes fasting during Ramadan.
Dr. Mohamed Hassanein, Chair of DAR International Alliance and proponent of the conference explained that the groups intention is to facilitate throughout the year to help inform people of better choices whether a healthcare professional who needs evidence-based findings or a person with diabetes to accept the information. One of the case studies presented during the conference was conducted at Dubai Hospital an education campaign aimed at pregnant women with diabetes. Due to the education programme called DAR SAFA or safe fasting, over 50% of women managed to change their opinion about fasting in Ramadan, whether before the Holy Month itself or as soon as they had a hypoglyceamic episode and stopped fasting.

The community is of key importance in working together to spread awareness, said Dr. Hassanein: The alliance is not an alliance among doctors only. It is for those with an interest in diabetes and certainly the religious authorities and the media also form a very important part of that alliance. Dr. Hassanein said that education for diabetes patients involves three levels which include the general public, the healthcare professionals such as nurses, midwives, pharmacists and others in primary care positions, and most importantly, a designated structure of educational tool appropriate with the local language and culture.
According to Lilly, a supporter of DAR and its initiatives, educating patients and encouraging them to discuss a treatment plan for Ramadan fasting with their doctor can be a major challenge to find the right tools and resources, including time and personnel.

Since 2013, a Conversation Map tool, specific to Managing Diabetes during Ramadan has been widely used across the region. The tool created by Healthy Interactions, in collaboration with IDF and launched with the support of Lilly Diabetes, is available in more than 40 countries and in more than 30 languages. More than 18,000 patients in South Asia, the Middle East and Africa have already used it to plan for their Ramadan fasting.
The tool, showcased at Lilly booth in the 3rd DAR International Alliance conference, represents an innovative approach to educate patients through dialogue with health experts certified to moderate the sessions by the International Diabetes Federation, according to Dr Lamiya Rizvi, Medical Director for Lilly Middle East. The map is created specifically for the people with diabetes who choose to fast during Ramadan. It helps doctors and nurses guide their patients on how to daily manage diabetes, understand myths and facts about diabetes, the major complications to watch out during fasting and the important habits to maintain while fasting, she adds.