Clinical Review

Management of people with diabetes wanting to fast during Ramadan

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c3053 (Published 22 June 2010) Cite this as: BMJ 2010;340:c3053
  1. E Hui, specialist registrar1,
  2. V Bravis, academic research fellow1,
  3. M Hassanein, consultant physician2,
  4. W Hanif, consultant physician3,
  5. R Malik, professor of medicine4,
  6. T A Chowdhury, consultant physician5,
  7. M Suliman, consultant physician6,
  8. D Devendra, consultant community diabetologist17
  1. 1Department of Investigative Science, Imperial College London, London
  2. 2Department of Diabetes, Glan Clwyd Hospital, Rhyl
  3. 3Department of Diabetes and Endocrinology, University Hospital Birmingham, Birmingham
  4. 4Cardiovascular Research Group, University of Manchester, Manchester
  5. 5Department of Diabetes, Barts and the London NHS Trust, London
  6. 6Department of Medicine, Royal Preston Hospital, Preston
  7. 7Northwest London NHS Trust and Brent Community Services, London
  1. Correspondence to: D Devendra, Jeffrey Kelson Diabetes Centre, Central Middlesex Hospital, London NW10 7NS d.devendra{at}imperial.ac.uk
  • Accepted 28 May 2010

Summary points

  • Ramadan is one of the five main pillars of Islam

  • Muslims are obliged to abstain from food and drink from dawn to sunset during the month of Ramadan

  • Muslims with diabetes may be exempted from fasting during Ramadan, although a high proportion fast

  • Patients with diabetes who fast risk hypoglycaemia, hyperglycaemia, and dehydration

  • Guidelines from the National Institute for Health and Clinical Excellence emphasise the importance of individualising care on the basis of patients’ social, cultural, and religious needs

  • Diabetic patients who want to fast need an assessment before Ramadan and education to increase their awareness of the risks of fasting

The holy month of Ramadan is one of five main pillars of being a Muslim. Most Muslims are passionate about fasting during this month. Although the Koran exempts sick people from the duty of fasting,1 2 many Muslims with diabetes may not perceive themselves as sick and are keen to fast. A large epidemiological study of Muslims with diabetes in 13 Muslim countries (n=12 914)—the EPIDIAR study—showed that 43% of patients with type 1 and 79% of those with type 2 diabetes fasted during Ramadan.3

As the month of Ramadan follows the lunar calendar, the fasting month is brought forward by about 10 days each year, which means that over time the season in which Ramadan falls changes. For the next decade Ramadan will fall in the summer in the northern hemisphere. As daylight hours vary considerably between summer and winter months in non-equatorial countries, the length of the fast (which lasts from dawn to sunset) increases in the summer (to about 16-20 hours). People with diabetes who fast are at risk of adverse events, and the risks may increase with longer fasting periods. We review the evidence for optimum management of diabetic patients who wish to fast …

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