Ramadan offers an opportunity to Muslims to achieve good control of Diabetes-Prof. Abdul Jabbar


 Diabetes and Ramadan Session during IDEC 2016

Ramadan offers an opportunity to Muslims to
achieve good control of Diabetes-Prof. Abdul Jabbar

63% physicians in CREED Study and 68% physicians
in EPIDIAR study consulted Ramadan Guidelines

KARACHI: Prof.  Suleman Abusrewil from Libya along with Dr. Mohammad Elton from Sudan chaired this session devoted to Diabetes and Ramada on the second day of the International Conference on Diabetes and Endocrinology 2016 organized by Baqai Institute of Diabetes and Endocrinology (BIDE) held from August 19-21st 2016 at Karachi.  Prof. Abdul Jabbar a noted Pakistani diabetologist currently settled in UAE who has done lot of work on this topic was the main speaker. In his excellent presentation Prof. Jabbar talked about Diabetes and Ramadan: Journey from 2000-2016 and gave salient features of CREED as well as EPIDIAR studies wherein he was one of the important investigators.

Prof. Abdul Jabbar 

Prof. Jabbar pointed out that Muslim counties are in majority in the top ten countries with highest adult population with diabetes mellitus. Further there is heat and humidity in these Muslim countries. Asia Pacific and MENA Region has the largest Muslim population. For the EPIDIAR study, one hundred physicians were selected from each country and they selected first ten patients who were eligible for inclusion in this study. The study was conducted in thirteen countries. Information collected included disease history, treatment approach, physical activity, eating habits. It included 12,243 patients of which 91% were suffering from Type 2 diabetes and 9% from Type1 diabetes. Findings of this study were first published in 2004. This study showed that 42.6% of Type 1 and 78.7% of Type 2 diabetics were fasting. About 50% had no life style change in Ramadan and a significant number of patients reported hypoglycemia and severe hypoglycemia episodes during Ramadan.

CREED study was designed in 2010. This was an observational study conducted in Muslim countries.  A total of five hundred eight physicians were selected from thirteen countries. Inclusion criteria was that the patient must be on medication. This study showed that 94.2% of Muslims with Type 2 diabetes were fasting during half the month of Ramadan while two third of these patients had fast during the whole month of Ramadan. In Algeria 83.5% had total fast, Morocco had 22.9% full fast. About 32% had fast for fifteen days only. In CREED study 76.6% of patients were on oral hypoglycemic medications while this figure was 78.4% in EPIDIAR study.  In CREED study the use of oral monotherapy decreased but combinations of two oral drugs increased. It also showed that 63% physicians in CREED study and 68% physicians in EPIDIAR study used Ramadan Guidelines. About 25% of EPIDIAR study patients changed their pre Ramadan   oral therapy. It also showed that Ramadan Guidelines are not consulted by all physicians. In CREED study about 30% of physicians did not consult these guidelines, 70% physicians did consult these RAMADAN guidelines but their patients did not bother. Fasting, he said, is associated with life style changes and it has an impact on new metabolic state. Education, Prof. Abdul Jabbar stated, was an essential component of diabetes management. Those at risk must monitor their blood glucose regularly, ensure medication and proper exercise. It is not only the patients with diabetes but physicians as well who need to be educated. Obesity is a disease which should be emphasized by the doctors as well as research scientists who should unify their decisions.

Prof. Wasim Hanif 

Prof. Wasim Hanif from Birmingham UK was the next speaker and his presentation was on Formulating Guidelines for Diabetes Management during Ramadan: Do we have enough Evidence? He advocated applying the culturally sensitive approach. He was of the view that we need to look into the information available, studies done so far and then make any change in our attitude as regards Fasting and Ramadan. In Randomized Controlled Trials it is shown but in controlled longitudinal studies it shows that it is like that but in uncontrolled studies these are signs and experts opinions are observations. RCTs are more reliable for determining benefits. Currently there are 415 Million people with diabetes and this figure is likely to go up to 642 Million by the Year 2040.  We need to study the short and long term consequences of fasting, more suitable medications, adequate dose. During fasting insulin secretions decreases, Glycogen stores are depleted, ketones are used as fuel. Sleep and meal patterns change during Ramadan. He then referred to nine RCTs and seven observational studies wherein hypoglycemia was not significant. Now trial physicians are becoming better looking beyond hypoglycemia with composite end points of safety.  He was of the view that we need more trials and religious edicts.  About 1.6 Billion Muslim population in the world has high prevalence of diabetes. Many guidelines are published but there are very few RCTs. Many collaborative groups are working on more observational studies. He then referred to CAN-DO Ramadan study for which he said, we need more funds from Qatar Foundation and Gulf based organizations.