Ramazan Orucu Tutan Diabetes Mellitus Hastalarında Kendi Kendine Glikoz Takibinin Glisemik Kontrole Etkisi

Yıl 2022, Cilt: 6 Sayı: 1, 27 - 33, 27.03.2022

Nazire Aladağ Seydahmet Akın Yasemin Özgür Banu Böyük Özcan Keskin

https://doi.org/10.30565/medalanya.943781

Öz

Amaç: Diyabetli hastaların önemli bir bölümünün, doktorlarının ve güvenilir otoritelerin tavsiyelerine rağmen Ramazan ayında oruç tutmakta ısrar ettiği bilinmektedir. Bu hastalara mümkün olan en iyi bakım ve desteği sağlamak için, International Alliance tarafından Uluslararası Diyabet Federasyonu (IDF) ve Diyabet ve Ramazan (DAR) Uluslararası İttifakı pratik kılavuzları oluşturulmuştur. Bu çalışmanın amacı, Ramazan orucu tutan diyabetik hastalarda hekime danışma ve kendi kendine glukoz izleminin diyabet yönetimine etkisini araştırmaktı.

Yöntem: Bu retrospektif gözlemsel çalışmaya diyabet tanısı konan, diyabet polikliniğine Ramazandan sonra kontrole gelen ve Ramazan öncesi poliklinik takibini yapan 18 yaş üstü hastalar dahil edildi. Oruç tutmuş olan hastalara (öncesinde tutmuş olan ve olmayan) daha önceki oruç deneyimleri, Ramazandan önce doktora danışıp danışmadıkları, oruç tutanların bu Ramazanı nasıl geçirdikleri sorulup anket doldurulmuştur. Oruç tutan hastaların Ramazan öncesi ve sonrası biyokimyasal verileri analiz edildi.

Bulgular: Çalışmaya 98'i (%24.9) oruç tutan 394 diyabetli hasta katıldı. Oruç tutan diyabetli hastaların yaş ortalaması 59.7 ± 12.3 yıl olup, % 39.2'si kadındı. Oruç tutanların %86.7'sinin 15 günden fazla oruç tuttuğu tespit edildi. Erkeklerde açlık oranları kadınlara göre daha yüksekti (%32.4 - %20.8) Tip 2 DM'li hastaların %25.9'unun, tip 1 DM'li hastaların %10.3'ünün oruç tuttuğu saptandı. Oruç tutmak isteyen hastaların %62.8'inin bu konuda hekime başvurduğu, %55.3'ünün hekim tarafından risk tespit edildiği ve %70'inin kendi kendine kan glukoz izlemi (SMBG) ile takip edildiği belirlendi. Oruç tutan hastaların %23.4'ünün (23/98) kullanılan diyabet ilaçlarının sayısında veya dozunda azalma olduğu; %5.1 (5/98) orucu bozacak bir komplikasyon yaşandığı; %16,3'ünün kilo aldığı (2.8 ± 2.4 kg) ve %23.5'i kilo verdiği (2.7 ± 1.9 kg) gözlendi. HbA1c'de belirgin bir artış ve idrar albumin atılımında anlamlı bir düşüş saptandı. Kişisel kan şekerini takip edenlerin A1c kontrolünün takip etmeyenlere göre daha iyi korunduğu belirlendi.

Sonuç: Çalışmamızda diyabetli hastaların dörtte birinin oruç tuttuğu görüldü. Bu çalışmanın en değerli sonucu, diyabet hastalarının, Ramazan ayında doktor konsültasyonu alıp almadıklarına bakılmaksızın, SMBG ile kendi kendine oto kontrol mekanizması sağlayarak daha başarılı bir diyabet kontrolü elde etmiş olmasıdır.

Anahtar Kelimeler

diabetes mellitus, : Ramazan orucu, diabetes mellitus, glisemik kontrol

The effect of self glucose monitoring on glycemic control of patients with diabetes mellitus fasting during Ramadan

Öz

Aim: It is known that a significant number of patients with diabetes insist on fasting in the month of Ramadan, despite the advice of their physicians and reliable authorities. In order to provide the best possible care and support to these patients, the International Diabetes Federation (IDF) and the Diabetes and Ramadan (DAR) International Alliance practical guidelines have been created by the International Alliance. The aim of this study was to investigate the effect of consulting a physician and self glucose monitoring on diabetes management during Ramadan in patients with fasting diabetes.

Methods: With this retrospective observational study, patients over 18 years of age who were diagnosed with diabetes, who came to the diabetes outpatient clinic for control after Ramadan and who made their follow-up from our outpatient clinic before Ramadan, were included. Everyone who intends to fast (previous or not) has been asked about previous fasting experiences, questions about whether they consulted the doctor before Ramadan, and those who fasted, how they spent this Ramadan, the questionnaire was filled. The biochemical data of fasting patients before and after Ramadan were analyzed.

Results: A total of 394 patients with diabetes participated in the questionnaire and 98 of them (24.9 %) who were fasted were included in the study. The mean age of the fasting patients with diabetes was 59.7 ± 12.3 years and39.2 %werefemale. It was detected that 86.7% of the fasting people were fasting for more than 15 days. Fasting rates were higher in males than females (32.4% to 20.8%) It was found that 25.9% of patients with type 2 DM and 10.3% of patients with type 1 DM were fasting. It was determined that 62.8% of the patients intending to fast were consulted to the physician about this subject, 55.3% of them were determined risk by physician and 70% of them followed up with selfmonitoring blood glucose (SMBG). It was determined that 23.4% (23/98) of fasting patients had a reduction in the number or dose of diabetes medications used; 5.1% (5/98) experienced a complication that would disrupt fasting; 16.3% gained weight (2.8 ± 2.4 kg) and 23.5% lost weight (2.7 ± 1.9 kg). A significant increase in HbA1c and a significant decrease in UACR were detected. It has been determined that A1c control of those who follow with SMBG is better protected than those who do not.

Conclusion: In our study, it was seen that a quarter of patients with diabetes fasted. The most valuable result of this study is that the diabetic patients have achieved a more successful diabetes control by providing self-auto control mechanism with SMBG, regardless of whether or not they have received medical advice by physician consultationin Ramadan.

Anahtar Kelimeler

ramadan fasting, diabetes mellitus, glycemic control

Kaynakça

• 1. Ahmed MH, Husain NE, Elmadhoun WM, Noor SK, Khalil AA, Almobarak AO. Diabetes and Ramadan: A concise and practical update. J Family Med Prim Care. 2017;6(1):11-8. doi: 10.4103/2249-4863.214964.
• 2. Salti I, Bénard E, Detournay B, Bianchi-Biscay M, Le Brigand C, Voinet C et al. EPIDIAR study group. 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(10):2306-11. doi: 10.2337/diacare.27.10.2306.
• 3. Babineaux SM, Toaima D, Boye KS, Zagar A, Tahbaz A, Jabbar A et al. Multi-country retrospective observational study of the management and outcomes of patients with Type 2 diabetes during Ramadan in 2010 (CREED). Diabet Med. 2015;32(6):819-28. doi: 10.1111/dme.12685.
• 4. 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. doi: 10.1016/j.diabres.2017.03.003.
• 5. Iskandar WJ, Handjaja CT, Salama N, Anasy N, Ardianto MF, Kusumadewi D. Evidence-based case report: acute diabetic complication risks of Ramadan fasting in type 2 diabetics. Acta Med Indones. 2013;45(3):235-9. PMID: 24045396.
• 6. Hanif W, Lessan N, Basit A. “Physiology of ramadan fasting,” in Diabetes and Ramadan: Practical Guidelines, İnternational Diabetes Federation. 2016:29-39
• 7. Bener A, Yousafzai MT. Effect of Ramadan fasting on diabetes mellitus: a population-based study in Qatar. J Egypt Public Health Assoc. 2014;89(2):47-52. doi: 10.1097/01.EPX.0000451852.92252.9b.
• 8. Ismail NA, Olaide Raji H, Abd Wahab N, Mustafa N, Kamaruddin NA, Abdul Jamil M. Glycemic Control among Pregnant Diabetic Women on Insulin Who Fasted During Ramadan. Iran J Med Sci. 2011;36(4):254-9. PMID: 23115409
• 9. Khatib FA, Shafagoj YA. Metabolic alterations as a result of Ramadan fasting in non-insulin-dependent diabetes mellitus patients in relation to food intake. Saudi Med J. 2004;25(12):1858-63. PMID: 15711655.
• 10. Ziaee V, Razaei M, Ahmadinejad Z, Shaikh H, Yousefi R, Yarmohammadi L et al. The changes of metabolic profile and weight during Ramadan fasting. Singapore Med J. 2006;47(5):409-14. PMID: 16645692.
• 11. Kul S, Savaş E, Öztürk ZA, Karadağ G. Does Ramadan fasting alter body weight and blood lipids and fasting blood glucose in a healthy population? A meta-analysis. J Relig Health. 2014;53(3):929-42. doi: 10.1007/s10943-013-9687-0.
• 12. Gnanou JV, Caszo BA, Khalil KM, Abdullah SL, Knight VF, Bidin MZ. Effects of Ramadan fasting on glucose homeostasis and adiponectin levels in healthy adult males. J Diabetes Metab Disord. 2015;14:55. doi: 10.1186/s40200-015-0183-9.
• 13. Sahin SB, Ayaz T, Ozyurt N, Ilkkilic K, Kirvar A, Sezgin H. The impact of fasting during Ramadan on the glycemic control of patients with type 2 diabetes mellitus. Exp Clin Endocrinol Diabetes. 2013;121(9):531-4. doi: 10.1055/s-0033-1347247.
• 14. Karatoprak C, Yolbas S, Cakirca M, Cinar A, Zorlu M, Kiskac M et al. The effects of long term fasting in Ramadan on glucose regulation in type 2 diabetes mellitus. Eur Rev Med Pharmacol Sci. 2013;17(18):2512-6. PMID: 24089232.
• 15. Katibi IA, Akande AA, Bojuwoye BJ, Okesina AB. Blood sugar control among fasting Muslims with type 2 diabetes mellitus in Ilorin. Niger J Med. 2001;10(3):132-4. PMID: 11806014.
• 16. 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). Diabetes Metab. 2015;41(1):28-36. doi: 10.1016/j.diabet.2014.11.004.
• 17. Bouhlel E, Zaouali M, Miled A, Tabka Z, Bigard X, Shephard R. Ramadan fasting and the GH/IGF-1 axis of trained men during submaximal exercise. Ann Nutr Metab. 2008;52(4):261-6. doi: 10.1159/000140517. 18. M'guil M, Ragala MA, El Guessabi L, Fellat S, Chraibi A, Chabraoui L et al. Is Ramadan fasting safe in type 2 diabetic patients in view of the lack of significant effect of fasting on clinical and biochemical parameters, blood pressure, and glycemic control? Clin Exp Hypertens. 2008;30(5):339-57. doi: 10.1080/10641960802272442.
• 19. Norouzy A, Mohajeri SM, Shakeri S, Yari F, Sabery M, Philippou E et al. Effect of Ramadan fasting on glycemic control in patients with Type 2 diabetes. J Endocrinol Invest. 2012;35(8):766-71. doi: 10.3275/8015.
• 20. Bouguerra R, Jabrane J, Maâtki C, Ben Salem L, Hamzaoui J, El Kadhi A et al. La pratique du jeûne du mois de Ramadan chez le diabétique de type 2 [Ramadan fasting in type 2 diabetes mellitus]. Ann Endocrinol (Paris). 2006;67(1):54-9. French. doi: 10.1016/s0003-4266(06)72541-0.
• 21. Kamar M, Orabi A, Salem I, EL- Shabrawy A. Effect Of Ramadan Fastıng On Dıabetıc Mıcro-Vascular Complıcatıon. Zagazig Univ. Med. J. 2014;20(2):1-13, doi: 10.21608/zumj.2014.4370.
• 22. Esmaeilzadeh F, van de Borne P. Does intermittent fasting improve microvascular endothelial function in healthy middle-aged subject Biol. Med (Aligarh)., 2016,8(6):1-9. doi: 10.4172/0974-8369.1000337.
• 23. Savaş E. Attitudinal Determinants of Turkish Diabetic Patients and Physicians About Ramadan Fasting. J Relig Health. 2018;57(1):47-56. doi: 10.1007/s10943-016-0327-3.
• 24. Bravis V, Hui E, Salih 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(3):327-31. doi: 10.1111/j.1464-5491.2010.02948.x.