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

  1. Ibrahim Salti, MD, PHD1,
  2. Eric Bénard, MD2,
  3. Bruno Detournay, MD, MBA2,
  4. Monique Bianchi-Biscay, MD3,
  5. Corinne Le Brigand4,
  6. Céline Voinet2,
  7. Abdul Jabbar, MD5 and
  8. on behalf of the EPIDIAR Study Group*
  1. 1Division of Endocrinology and Metabolism, American University of Beirut, Beirut, Lebanon
  2. 2Cemka-Eval, Bourg La Reine, France
  3. 3Aventis Pharma International, Antony, France
  4. 4Alios Conseil, Paris, France
  5. 5Diabetes and Endocrinology Section, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
  1. Address correspondence and reprint requests to Dr. Monique Bianchi-Biscay, Aventis Intercontinental, 20 Ave. Raymond Aron, 92160 Antony, France. E-mail: monique.bianchi-biscay{at}


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.


  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

  • *

    * A complete list of the EPIDIAR Study Group members is available at

    • Accepted June 25, 2004.
    • Received October 28, 2003.
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