Diabetes and Ramadan: Gathering Data to Improve Clinical Care While Fasting

Muslims engage in an obligatory, month-long, sunrise-to-sunset fast once a year during Ramadan. In 2005, the American Diabetes Association developed recommendations for managing diabetes during Ramadan. They updated the recommendations in 2010, and this document has become one of their more popular publications.

Two articles were published recently that discuss managing diabetics in Ramadan. Researchers from Panteion University in Athens, Greece have written a letter to the editor in the journal Hormones that succinctly summarizes Ramadan and its health implications. BMJ Open Diabetes Research and Care has published a review article in January 2016 that summarizes and updates the ADA recommendations.

Clinicians can stratify patients by risk of hypoglycemia and/or complications before Ramadan's fasting period starts. They should advise patients with the highest risk of hypoglycemia or multiple diabetic complications against prolonged fasting.

Patients who have less risk of hypoglycemia may have trouble dealing with no food or water/drink for many hours, or taking oral medications during the day. Both articles recommend educating patients, and specifically, discussing glucose monitoring and treatment regimens before Ramadan begins.

The BMJ Open Diabetes Research and Care article has very specific recommendations about medications. They report that metformin, thiazolidinediones and dipeptidyl peptidase-4 inhibitors appear to be safe and do not need dose adjustment.

Chlorpropamide or glyburide, should not be used. Clinicians should use extreme caution in patients taking most sulfonylureas during Ramadan; other drugs are preferred. They'll need to reduce the sulfonylurea dose with consideration of the patient's degree of control prior to fasting.

Patients should take their once-daily sulfonylureas before Iftar (i.e. the meal after sunset, with appropriate dosage adjustments). Those taking twice-daily sulfonylureas should schedule doses before Suhur (i.e. the meal before sunrise) should be halved, with an unchanged sulfonylureas dose before Iftar.

Muslims who are temporarily sick or traveling are excluded from fasting, as are women who are pregnant, breastfeeding or menstruating. Patients with serious and/or chronic health problems (e.g. diabetes or cardiovascular disease) are also exempt.