Recommendations for Management of Diabetes During Ramadan
- Monira Al-Arouj, MD1,
- Radhia Bouguerra, MD2,
- John Buse, MD, PHD3,
- Sherif Hafez, MD, FACP4,
- Mohamed Hassanein, FRCP5,
- Mahmoud Ashraf Ibrahim, MD6,
- Faramarz Ismail-Beigi, MD, PHD7,
- Imad El-Kebbi, MD8,
- Oussama Khatib, MD, PHD9,
- Suhail Kishawi, MD10,
- Abdulrazzaq Al-Madani, MD11,
- Aly A. Mishal, MD, FACP12,
- Masoud Al-Maskari, MD, PHD13,
- Abdalla Ben Nakhi, MD1 and
- Khaled Al-Rubean, MD14
- 1Ministry of Health, Amiri Hospital, Rawda, Kuwait
- 2National Institute of Nutrition, Tunis, Tunisia
- 3Diabetes Care Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- 4Department of Internal Medicine & Diabetes, Faculty of Medicine, Cairo University, Cairo, Egypt
- 5Department of Medicine, Glan Clwyd Hospital, Rhyl, Denbighshire, U.K.
- 6Egyptian Diabetes Center, Cairo, Egypt
- 7Division of Clinical and Molecular Endocrinology, Case Western Reserve University, Cleveland, Ohio
- 8Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- 9Regional Advisor/Non Communicable Diseases/World Health Organization/Eastern Mediterranean Region, Cairo, Egypt
- 10Ministry of Health, Palestinian National Authority, Ghaza, Palestine
- 11Dubai Hospital, Dubai, United Arab Emirates
- 12Diabetes & Endocrinology Center, Islamic Hospital, Amman, Jordanm
- 13College of Medicine, Sultan Qaboos University, Sultante of Oman
- 14Diabetes Center, Medical College, King Saud University, Riyadh, Saudi Arabia
- Address correspondence and reprint requests to Mahmoud Ashraf Ibrahim, MD, 19 Nasouh St., Zeitoun, Cairo 11321, Egypt. E-mail: mahmoud{at}arab-diabetes.com
- DCCT, Diabetes Control and Complications Trial
- EPIDIAR, Epidemiology of Diabetes and Ramadan 1422/2001
It is estimated that there are 1.1–1.5 billion Muslims worldwide, comprising 18–25% of the world population (1,2). Fasting during Ramadan, a holy month of Islam, is an obligatory duty for all healthy adult Muslims. An ∼4.6% prevalence of diabetes worldwide (3) coupled with the results of the population-based Epidemiology of Diabetes and Ramadan 1422/2001 (EPIDIAR) study, which showed (in 12,243 people with diabetes from 13 Islamic countries) that ∼43% of patients with type 1 diabetes and ∼79% of patients with type 2 diabetes fast during Ramadan (4), lead to the estimation that some 40–50 million people with diabetes worldwide fast during Ramadan.
Ramadan is a lunar-based month, and its duration varies between 29 and 30 days. Its timing changes with respect to seasons. Depending on the geographical location and season, the duration of the daily fast may range from a few to more than 20 h. Muslims who fast during Ramadan must abstain from eating, drinking, use of oral medications, and smoking from predawn to after sunset; however, there are no restrictions on food or fluid intake between sunset and dawn. Most people consume two meals per day during this month, one after sunset, referred to in Arabic as Iftar (breaking of the fast meal), and the other before dawn, referred to as Suhur (predawn). Fasting is not meant to create excessive hardship on the Muslim individual. The Koran specifically exempts the sick from the duty of fasting (Holy Koran, Al-Bakarah, 183–185), especially if fasting might lead to harmful consequences for the individual. Patients with diabetes fall under this category because their chronic metabolic disorder may place them at high risk for various complications if the pattern and amount of their meal and fluid intake is markedly altered. This exemption represents more than a simple permission not to …
