Diabetes education and medication adjustment in Ramadan (DEAR) program prepares for self-management during fasting with tele-health support from pre-Ramadan to post-Ramadan

Abstract

Background: We evaluated the outcome for fasting Muslims with diabetes prepared with pre-Ramadan optimization through education and medication adjustment, tele-support and intervention up to post-Ramadan. Methods: Muslims with diabetes planning to fast were recruited into a focused diabetes program for Ramadan fasting. It consisted of (a) a pre-Ramadan assessment and test fasting to optimize glycemic control, (b) education on diabetes management during fasting, (c) tele-monitoring from pre-Ramadan and (d) a post-Ramadan review. Their metabolic profiles and diaries for meals, activities and glucose monitoring were evaluated. Results: Twenty-nine participants were enrolled, with mean age 58.4 ± 9.2 years, 75.9% female, 79.3% Malays and 93.1% type 2 diabetes. A total of 92% needed medication adjustment and 93% fasted for at least 14 days. Glycated hemoglobin (HbA1c) and weight decreased from 8.8 ± 1.8% (72.7 mmol/mol) pre-Ramadan to 8.5 ± 1.7% (69.4 mmol/mol) post-Ramadan and 76.6 ± 20.3 kg pre-Ramadan to 75.9 ± 21.3 kg post-Ramadan, respectively. There were decreased complications of hypoglycemia from 13.8% to 10.3% and several-fold improvement in hyperglycemia from 31.0% to 3.5% during Ramadan fasting when compared with pre-Ramadan. Conclusions: Muslims with diabetes were able to self-manage when fasting using tele-monitoring support and intervention, with decreased complications during Ramadan compared with pre-Ramadan.