Ramazan'da oruç tutmanın tip 2 diyabetik hastalara etkisi

Year 2019, Volume: 44 Issue: 3, 758 - 763, 30.09.2019

Filiz Ekşi Haydardedeoğlu Gülay Şimşek Bağır , Akatlı Kürşat Özşahin

https://doi.org/10.17826/cumj.496374

Cited By: 1

Abstract

Amaç: Ramazan ayında oruç tutmak Müslümanlar için dini bir zorunluluktur. Uzamış açlık bu hastaları hipoglisemi ya da hiperglisemi gibi akut komplikasyonlarla karşı karşıya getirmektedir. Bu çalışmada Ramazan ayında oruç tutan bireylerde açlığın glukoz regülasyonu üzerine etkisini araştırmayı amaçladık.

Gereç ve Yöntem: Hastalar uzun süreli açlığın olası komplikasyonları hakkında bilgilendirildikten sonra Ramazan ayında oruç tutacağını beyan eden bireylerle  Ramazan ayı bitiminden 1 ay sonra telefon görüşmesi yapıldı. Telefon görüşmesiyle gerçekleştirilen bu retrospektif kohort çalışmada, kaç gün oruç tuttukları, günlük glukoz ölçümleri, eğer yaşadılarsa hipoglisemik atak sayısı ve tedavilerini değiştirip değiştirmedikleri soruldu.

Bulgular: Çalışmaya 46 diyabetik hasta dahil edildi. Ortalama yaş 54.3±9.5 saptandı. Ortalama oruç tutulan gün sayısı 25.24±2.4 idi. Hastalar risk sınıflamasına göre gruplandırıldı. Hipoglisemik atak sayısında ramazandan önceki 6 ay içinde saptanan atak sayısına göre fark saptanmadı. Hastalarda hiperglisemi, hipoglisemiye göre daha yüksek sıklıkla tespit edildi. Hipoglisemi ya da hiperglisemi yaşayan bireylerin oruç tutmaya devam ettikleri ve tedavilerinide değişiklik yapmadıkları belirlendi.

Sonuç: Ramazan ayında oruç tutan bireylerde hem hipoglisemi hem de hiperglisemi yatkınlığı mevcuttur. Glisemik regülasyonu düzeltmek ve bu bireyleri güvenli, kabul edilebilir glukoz aralığında tutabilmek için, diyabetik bireylerin Ramazan öncesi eğitimleri ve bilgilendirilmeleri gereklidir.

Keywords

Ramazan, diyabet, hipoglisemi

Impact of fasting during Ramadan in patients with type 2 diabetes mellitus

Abstract

Purpose: Fasting during Ramadan is a religious obligation for Muslims. Extended fasting can create undesirable acute complications of diabetes such as hypoglycemia or hyperglycemia. In this study, we aimed to evaluate the impact of fasting on glucose regulation in diabetic patients who fast during Ramadan.

Materials and Methods: Patients were informed about the possible side effects of fasting for them and those who stated that they will be fasting during Ramadan were called one month after Ramadan. In this retrospective cohort study by telephone interview, the number of fasting days,  daily measurements of glucose, the number of acute complications if existed and whether the patients  have changed their treatments were asked.

Results: Forty six patients were included in this study.  Mean age was 54.3±9.5 yr. The average fasting day was 25.24±2.4. They were categorized according to the risk stratifications. The number of hypoglycemic events was not higher than detected six months prior to the Ramadan. Most of the patients had hyperglycemia rather than hypoglycemia. All of the patients who had hypo-or hyperglycemia did not interrupt their fasting and did not change their medications. 

Conclusion: Patients who fasted during Ramadan have a tendency both hypoglycemia and hyperglycemia. To improve glycemic regulation and keep these patients in a safe and acceptable glucose range, Pre-Ramadan education is necessary.

Keywords

Ramadan, diabetes, hypoglycemia

References

• 1. Fereidoun Azizi. Islamic Fasting and Health. Ann Nutr Metab. 2010;56: 273–282.
• 2. Salti I, Bénard E, Detournay B, Bianchi-Biscay M, Le Brigand C, Voinet C, et al. A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diabetes Care. 2004;27:2306–11.
• 3. Jabbar A, Hassanein M, Beshyah SA, Boye KS, Yu M, Babineaux SM. CREED study: Hypoglycaemia during Ramadan in individuals with Type 2 diabetes mellitus from three continents. Diabetes Res Clin Pract. 2017;132:19-26.
• 4. S. Bajaj. Newer glucose-lowering therapy drugs in Ramadan. Journal of the Pakistan Medical Association. 2015;65(Suppl 5 ):40-43.
• 5. Hassanein M, Al-Arouj M, Hamdy O, Bebakar WMW, Jabbar A, Al-Madani A, et al. International Diabetes Federation (IDF), in collaboration with the Diabetes and Ramadan (DAR) International Alliance. Diabetes and Ramadan:Practical guidelines. Diabetes Res Clin Pract. 2017;126:303-316.
• 6. Ahmedani MY, Haque MS, Basit A, Fawwad A, Alvi SF. Ramadan prospective diabetes study: the role of drug dosage and timing alteration, active glucose monitoring and patient education. Diabet Med. 2012;29(6):709–15.
• 7. Hassanein M, Bravis V, Hui E, Devendra D. Ramadan-focused education and awareness in type 2 diabetes. Diabetologia. 2009;52(2):367–8.
• 8. Patel NR, Kennedy A, Blickem C, Rogers A, Reeves D, Chew-Graham C. Having diabetes and having to fast: a qualitative study of British Muslims with Diabetes. Health Expect. 2015;18:1698-708.
• 9. J aleel MA, Raza SA, Fathima FN, Jaleel BN. Ramadan and diabetes: As- Saum (The fasting). Indian J Endocrinol Metab. 2011;15(4):268–273.
• 10. Pinelli NR, Jaber LA. Practices of Arab American patients with type 2 diabetes mellitus during Ramadan. J Pharm Pract. 2011;24(2):211–215. 11. Cesur M, Corapcıoglu D, Gursoy A, Gonen S, Ozduman M, Emral R, et al. A comparison of glycemic effects of glimepiride, repaglinide and insulin glargine in type 2 diabetes mellitus during Ramadan fasting. Diabetes Res Clin Pract. 2007; 75:141-147.
• 12. Bravıs V, Hui E, Salıh S, Mehar S, Hassanein M, Devendra D. Ramadan Education and Awareness in Diabetes (READ) programme for Muslims with type 2 diabetes who fast during Ramadan. Diabet Med. 2010; 27:327-331.
• 13. Ahmedani MY, Haque MS, Basit A, Fawwad A, Alvi SF. Ramadan prospective diabetes study: the role of drug dosage and timing alteration, active glucose monitoring and patient education. Diabet Med. 2012;29:709-715.
• 14. Alfadhli ME. Higher rates of hyperglycemia than hypoglycemia during Ramadan fasting in patients with uncontrolled type 1 diabetes:Insight from continuous glucose monitoring system. Saudi Pharmaceutal Journal. 2018;26;965-969.
• 15. Lessan N, Hannoun Z, Hasan H, Barakat MT. Glucose excursions and glycaemic control during Ramadan fasting in diabetic patients:Insights from continuous glucose monitoring (CGM). Diabet. Metab. 2015;41;28-36.
• 16. Mikhael ME. Effectiveness and Safety of Newer Antidiabetic Medications for Ramadan Fasting Diabetic Patients. Journal of Diabetes Research 2016, Article ID 6962574, 10 pages http://dx.doi.org/10.1155/2016/6962574.
• 17. Bakiner O, Ertorer ME, Bozkirli E, Tutuncu NB, Demirag NG. Repaglinide plus single-dose insulin glargine: a safe regimen for low-risk Type 2 diabetic patients who insist on fasting in Ramadan. Acta Diabetologica. 2009;46:63-65.
• 18. Mustafa HE, Hashim T, Beshyah SA, Amin R, Eissa R, Tommy M, et al. The effect of “targeted diabetes education” on glycemic control during Ramadan fasting. Ibnosina J Med BS. 2012;4(6):242–248.