Impact Of Ramadan Focused Education Program On Hypoglycemic Risk And Metabolic Control For Patients With Type 2 Diabetes
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Date
2017-02
Authors
Tourkmani, Ayla Mhd. Dadou
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
Ramadan fasting is associated with significant impact on glycemic control and
patient safety among patients with type 2 diabetes (T2D). The burden of the problem is
high in Saudi Arabia due to the high prevalence of diabetes. The risk can be aggravated
by hot weather and long fasting duration during Ramadan in Saudi Arabia. Current
guidelines recommend counseling and educating patients with T2D before Ramadan.
Despite the higher risk among Saudi patients, based on the extensive literature review,
there is lack of studies examining the impact of Ramadan education program among
Saudi patients with T2D. Therefore, the aim of the study was to evaluate the impact of
Ramadan Focused Education Program (RFEP) on hypoglycemia risk score and other
related clinical & metabolic parameters (HbA1c, lipid profile, blood pressure, body
weight and body mass index (BMI). A prospective non-randomized interventional
controlled design was run on three phases: before, during and after Ramadan on 262
T2D patients at a large big family medicine center. The intervention group (n=140)
received focused individualized diabetic education sessions and antidiabetic medications
adjustment before and after Ramadan, while the control group (n=122) received standard
diabetic care. A validated hypoglycemic score was used in both groups to assess the
change of the risk. Patients were advised to adjust the dosage and timing of antidiabetic
agents according to the recommendations for management of diabetes during Ramadan.
Primary outcomes were post-intervention change of hypoglycemia score and HbA1c
over a 6-month follow-up. Data were presented as mean ± standard deviation. HbA1c
was expressed in percentage. The hypoglycemic scores before, during, and after
Ramadan were 14.21±8.50, 6.36±6.17, and 5.44±5.55 in the intervention group,
respectively (P<0.001) and 14.01±5.10, 13.46±5.30, and 9.27±4.65 in the control group,
respectively (P<0.001). HbA1c levels were 9.79±1.89, 8.26±1.54, and 8.52±1.61 before,
during, and after Ramadan in the intervention group, respectively (P<0.001), and
10.04±1.47, 9.54±1.38, and 9.59±1.79 in the control group, respectively (P<0.001).
Post-Ramadan reductions of HbA1c and hypoglycemic scores were significantly higher
in the intervention group (-13.0% vs -4.5%, P=0.004 for HbA1c and -61.7% vs -33.8%,
P<0.001 for hypoglycemic score). Low-density lipoprotein cholesterol improved in the
intervention group from 2.41±0.91 mmol/L before Ramadan to 2.28±0.68 mmol/L after
Ramadan (P<0.001). No statistically significant effects were observed on blood pressure
or body weight in the intervention group. Similarly, no change was observed in the
control group. The findings of the current study suggested that Ramadan educational
program has a positive impact with reduction of hypoglycemic risk, HbA1c, and lowdensity
lipoprotein cholesterol. Therefore, it could be recommended for patients with
increased risk of hypoglycemia during Ramadan fasting.
Description
Keywords
Metabolic control for patients , with Type 2 diabetes