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
- Ibrahim Salti, MD, PHD1,
- Eric Bénard, MD2,
- Bruno Detournay, MD, MBA2,
- Monique Bianchi-Biscay, MD3,
- Corinne Le Brigand4,
- Céline Voinet2,
- Abdul Jabbar, MD5 and
- on behalf of the EPIDIAR Study Group*
- 1Division of Endocrinology and Metabolism, American University of Beirut, Beirut, Lebanon
- 2Cemka-Eval, Bourg La Reine, France
- 3Aventis Pharma International, Antony, France
- 4Alios Conseil, Paris, France
- 5Diabetes and Endocrinology Section, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
- Address correspondence and reprint requests to Dr. Monique Bianchi-Biscay, Aventis Intercontinental, 20 Ave. Raymond Aron, 92160 Antony, France. E-mail:
OBJECTIVE—The aim of this study was to assess the characteristics and care of patients with diabetes in countries with a sizable Muslim population and to study diabetes features during Ramadan and the effect of fasting.
RESEARCH DESIGN AND METHODS—This was a population-based, retrospective, transversal survey conducted in 13 countries. A total of 12,914 patients with diabetes were recruited using a stratified sampling method, and 12,243 were considered for the analysis.
RESULTS—Investigators recruited 1,070 (8.7%) patients with type 1 diabetes and 11,173 (91.3%) patients with type 2 diabetes. During Ramadan, 42.8% of patients with type 1 diabetes and 78.7% with type 2 diabetes fasted for at least 15 days. Less than 50% of the whole population changed their treatment dose (approximately one-fourth of patients treated with oral antidiabetic drugs [OADs] and one-third of patients using insulin). Severe hypoglycemic episodes were significantly more frequent during Ramadan compared with other months (type 1 diabetes, 0.14 vs. 0.03 episode/month, P = 0.0174; type 2 diabetes, 0.03 vs. 0.004 episode/month, P < 0.0001). Severe hypoglycemia was more frequent in subjects who changed their dose of OADs or insulin or modified their level of physical activity.
CONCLUSIONS—The large proportion of both type 1 and type 2 diabetic subjects who fast during Ramadan represent a challenge to their physicians. There is a need to provide more intensive education before fasting, to disseminate guidelines, and to propose further studies assessing the impact of fasting on morbidity and mortality.