Importance of education in managing type 2 diabetes during Ramadan.

Approximately 50 million Muslim adults with type 1 diabetes (T1D) and type 2 diabetes (T2D) go without food or drink from sunrise to sunset during the month of Ramadan, despite having a religious exemption.1 For many Muslim people with diabetes, Ramadan is a religious conviction and the intermittent fasting is a key component of its observance. The EPIDIAR (Epidemiology of Diabetes and Ramadan) study investigated this phenomenon in 12 243 participants from 13 countries and observed that 43% of T1D patients and 79% of T2D patients fast during the month of Ramadan.2 Fasting during Ramadan potentially affects dietary habits, daily physical activity, sleeping patterns, glycemic control, weight, lipid profile, and food intake. Figure 1 shows a typical Ramadan day. The benefits and risks of intermittent fasting in people with T2D are still being explored. The latest findings suggest that fasting T2D patients might be at risk of hypoglycemia with inappropriate continuation of pharmacotherapies; patients with T1D have a 4.7-fold (0.14 vs 0.03 episodes per month) and patients with T2D have a 7.5-fold (0.03 vs 0.004 episodes per month) increased risk of severe hypoglycemia.1 Some other important potential complications of fasting for these patients are hyperglycemia, diabetic ketoacidosis, dehydration, and thrombosis. Vasan et al conducted a prospective assessment of dietary patterns in Muslim patients in Sweden with T2D who undertook fasting during Ramadan.3 Patients’ compliance with nutritional guidelines was poor, causing an increase in consumption of all dietary components (fat, carbohydrates, and proteins). The authors concluded that these patients needed close monitoring during fasting.