Culturally sensitive care: managing diabetes during Ramadan

Diabetes and its treatments can cause problems for Muslims who wish to take part in the fast during the holy month of Ramadan. This article offers information about the impact of various diabetes treatments, including insulin, when fasting and some of the precautions that need to be in place. Some of the reasons people with diabetes might find it difficult to comply with advice are explored with some suggestions on how to work towards acceptable compromises. Through dialogue between health professionals and patients, it is usually possible to facilitate at least some safe fasting for those who wish to observe this annual ritual.     

Vildagliptin therapy and hypoglycaemia in Muslim type 2 diabetes patients during Ramadan

Aims: To compare hypoglycaemic events, glycated haemoglobin (HbA_1c) and changes in bodyweight in metformin‐treated Muslim patients with type 2 diabetes receiving adjunctive treatment with vildagliptin or gliclazide during Ramadan fasting. Methods: Data were collected from Muslim patients with type 2 diabetes attending primary care practices in North West London, whose HbA_1c was > 8.5% despite treatment with metformin 2 g daily before Ramadan and who received gliclazide 160 mg twice daily (n = 26) or vildagliptin 50 mg twice daily (n = 26) in addition to metformin. Hypoglycaemic events, HbA_1c and weight were recorded 2 weeks before and 10 days after the Ramadan fast. All patients received education about how to identify and manage hypoglycaemia during Ramadan. Results: During Ramadan, at least one hypoglycaemic event (defined as blood glucose < 3.5 mmol/l with or without symptoms) was recorded in two patients receiving vildagliptin (7.7%) and 16 patients receiving gliclazide [61.5%; difference between groups ?53.8%, 95% confidence interval (CI) ?74.9 to ?26.3, p < 0.001]. Vildagliptin was associated with a reduction in the mean number of hypoglycaemic events during Ramadan compared with before Ramadan, whereas gliclazide was associated with an increase (least squares mean difference between groups ?0.66, 95% CI ?1.20 to ?0.13, p = 0.0168). Both gliclazide and vildagliptin were associated with similar reductions in HbA_1c and a small, but insignificant, increase in weight. Conclusions: Appropriate treatment adjustments can lead to improved diabetes management during Ramadan, with avoidance of significant weight gain and improved glucose control without hypoglycaemia. The addition of vildagliptin to metformin therapy during Ramadan in Muslim patients with type 2 diabetes was associated with a reduction in the incidence of hypoglycaemia.     

Comparison of Humalog Mix 50 with human insulin Mix 30 in type 2 diabetes patients during Ramadan

Aims: To compare hypoglycaemic events, glycated haemoglobin (HbA1c) and changes in body weight in Muslim patients with Type 2 diabetes receiving Humalog Mix 50 and human Mixtard 30 twice daily during Ramadan fasting. Methods: Data were collected from Muslim patients with Type 2 diabetes attending primary care practices in North‐West London, who were on Mixtard 30 insulin twice daily before Ramadan. Group 1 had their evening insulin changed to Humalog Mix 50 (n = 26) 2 weeks before Ramadan, i.e. taking Mixtard 30 at predawn meal and Humalog Mix 50 at the sunset meal during Ramadan. As the major proportion of the daily caloric intake was consumed at the sunset meal, the rationale of switching the evening dose from human Mixtard 30 to Humalog Mix 50 was to provide more rapid‐acting insulin that has shorter time of onset and peak time for the large evening meal to improve the postprandial glucose control without increasing the risk of hypoglycaemia. Group 2 continued on Mixtard 30 twice daily (n = 26). All patients received structured education about how to identify and manage hypoglycaemia during Ramadan. Results: Group 1 had a mean HbA1c reduction of 0.48% (p = 0.0001) before and after Ramadan, whereas group 2 had a mean HbA1c increase of 0.28% (p = 0.007). Group 1 was associated with a small reduction of 0.04 (p = 0.81) in the mean number of hypoglycaemic events during Ramadan compared with before Ramadan, whereas group 2 was associated with an increase of 0.15 (p = 0.43), although these differences between the groups were not statistically significant following adjustment for baseline factors [LSM difference between groups = 0.135, p = 0.36, 95% confidence limits (?0.16, 0.43)]. Conclusion: Changing to humalog Mix 50 during Ramadan resulted in improvement in glycaemic control without increasing the incidence of hypoglycaemia.     

Management of people with diabetes during Ramadan

In the UK, Islam is the second largest religion after Christianity and there are about 2.5 million Muslims living in the UK. Fasting is obligatory for all healthy adult Muslims during the holy month of Ramadan. During Ramadan, no food, drink, or medication is allowed between dawn and sunset. As a result of different research results there is no agreement on whether it is safe for Muslim diabetics to fast. Through dialogue between health professionals and patients, it is usually possible to facilitate at least some safe fasting for those who wish to observe this annual ritual. In this article some key pointers will be given for health professionals to consider with the aim of improving the quality of care of Muslim patients with diabetes during Ramadan.     

The incidence of hypoglycaemia in Muslim patients with type 2 diabetes treated with sitagliptin or a sulphonylurea during Ramadan: a randomised trial

Aims: To compare the incidence of symptomatic hypoglycaemia in fasting Muslim patients with type 2 diabetes treated with sitagliptin or a sulphonylurea during Ramadan. Methods: Patients with type 2 diabetes (age ≥ 18 years) who were treated with a stable dose of a sulphonylurea with or without metformin for at least 3 months prior to screening, who had an HbA_1c < 10% and who expressed their intention to daytime fast during Ramadan were eligible for this open‐label study. Patients were randomised in a 1 : 1 ratio to either switch to sitagliptin 100 mg qd or to remain on their prestudy sulphonylurea. Patients completed daily diary cards to document information on hypoglycaemic symptoms and complications. The primary end‐point was the overall incidence of symptomatic hypoglycaemia recorded during Ramadan. Results: Of the 1066 patients randomised, 1021 (n = 507 for sitagliptin and n = 514 for sulphonylurea) returned at least one completed diary card and were included in the analysis. The proportion of patients who recorded one or more symptomatic hypoglycaemic events during Ramadan was lower in the sitagliptin group (6.7%) compared with the sulphonylurea group (13.2%). The risk of symptomatic hypoglycaemia was significantly decreased with sitagliptin relative to sulphonylurea treatment (Mantel–Haenszel relative risk ratio [95% CI] = 0.51 [0.34, 0.75]; p < 0.001). There were no reported events that required medical assistance (i.e. visits to physician or emergency room or hospitalisations) or were considered severe (i.e. events that caused loss of consciousness, seizure, coma or physical injury) during Ramadan. Conclusions: In Muslim patients with type 2 diabetes who observed the fast during Ramadan, switching to a sitagliptin‐based regimen decreased the risk of hypoglycaemia compared with remaining on a sulphonylurea‐based regimen. The incidence of hypoglycaemia was lower with gliclazide relative to the other sulphonylurea agents and similar to that observed with sitagliptin.     

结构化教育在2型糖尿病病人教育中的应用研究

[目的]评估结构化教育模式对2型糖尿病病人自我管理能力的影响.[方法]将2010年6月-2011年6月60例使用胰岛素治疗的2型糖尿病病人随机分为干预组(结构化教育模式组)和对照组(常规护理组),观察病人末梢血糖水平、糖化血红蛋白、糖尿病管理自我效能等.[结果]6个月后两组空腹血糖、餐后2h血糖、糖化血红蛋白差异有统计学意义;干预组糖尿病自我管理效能得分明显提高(P＜0.001),糖尿病知识及格率由36.7％提高至86.7％.[结论]结构化教育对2型糖尿病病人自我管理能力有明显优势,有助于控制病人血糖,减少并发症,提高病人自我管理能力.     

结构化教育在2型糖尿病病人教育中的应用研究

[目的]评估结构化教育模式对2型糖尿病病人自我管理能力的影响。[方法]将2010年6月-2011年6月60例使用胰岛素治疗的2型糖尿病病人随机分为干预组（结构化教育模式组）和对照组（常规护理组）,观察病人末梢血糖水平、糖化血红蛋白、糖尿病管理自我效能等。[结果]6个月后两组空腹血糖、餐后2h血糖、糖化血红蛋白差异有统计学意义;干预组糖尿病自我管理效能得分明显提高（P〈O．001）,糖尿病知识及格率由36．7％提高至86．7％。[结论]结构化教育对2型糖尿病病人自我管理能力有明显优势,有助于控制病人血糖,减少并发症,提高病人自我管理能力。     

立体化结构式糖尿病教育的构建及效果评价

目的 探讨立体化结构式教育对2型糖尿病患者干预效应及有效方法 .方法 随机将86例2型糖尿病患者分为2组:对照组和干预组.对照组:自学糖尿病知识,观察随访1年;干预组:以改变知、信、行为目的 ,运用集体授课、网上咨询、定期家访3种方式,实施教育、监测、保健三位一体的立体化结构式糖尿病教育,制定个体化食谱及运动方案,进行心理、行为干预,为期2 w.由专职糖尿病护士负责指导,观察随访1年.每6个月复查1次体重、血压、腰围、臀围、空腹血糖、餐后2 h血糖、糖化血红蛋白、血脂.结果干预后糖尿病知识及格率达90.7%,体质指数、腰臀比、空腹血糖、餐后2 h血糖、糖化血红蛋白、收缩压、甘油三酯明显下降.结论立体化结构式教育能提高2型糖尿病患者自我管理能力,对2型糖尿病患者实施立体化结构式糖尿病教育是必要的、可行的、有效的,有助于控制糖尿病.     

Structured group-based education for type 2 diabetes in primary care

To determine the effectiveness of structured group-based diabetes education programmes in improving glycaemic control in adults with type 2 diabetes in primary care a criteria-based review was conducted. The review of the three controlled trials identified showed that although HbA(1c) decreased in two of the studies, these differences were not statistically significant. Based on the present review, there is no evidence to recommend such programmes. However, due to limitations of these studies and opposing results of another trial not included in the review because of the uncertainty about criteria requirements caution is recommended in the interpretation of these findings.