Self-Monitoring of Blood Glucose and Hypoglycemia Association During Fasting in Ramadan Among Patients with Diabetes

Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy Dovepress Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy downloaded from https://www.dovepress.com/ by 119.207.124.227 on 11-Jul-2020 For personal use only. open access to scientific and medical research Open Access Full Text Article ORIGINAL RESEARCH Self-Monitoring of Blood Glucose and Hypoglycemia Association During Fasting in Ramadan Among Patients with Diabetes This article was published in the following Dove Press journal: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy Deyaa Mansouri 1 Ebtehal Khayat 2 Mohannad Khayat 3 Muteb Aboawja 4 Areej Aseeri 5 Faisal Banah 6 Khulood Alsiary 7 Lama Abdulaziz Rammal Adel D Almalki 8 Mohammed Hasaballah 9 7 1 Hera General Hospital, Mecca, Saudi Arabia; 2Joint Program of Family Medicine, Mecca, Saudi Arabia; 3Joint Program of Community Medicine, Mecca, Saudi Arabia; 4King Faisal Medical City, Abha, Saudi Arabia; 5King Fahad Military Medical Complex, Dhahran, Saudi Arabia; 6 Armed Hospital Southen Rigon, KhamisMushait, Saudi Arabia; 7King Abdulaziz Medical City, Jeddah, Saudi Arabia; 8King Salman Bin Abdulaziz Hospital, Riyadh, Saudi Arabia; 9King Faisal Hospital, Mecca, Saudi Arabia Purpose: The study aims to assess current practices of patients with diabetes to control blood glucose levels during Ramadan. Patients and Methods: A cross-sectional approach has been used for collecting data through a structured and interview-based questionnaire to assess the association between self-monitoring of blood glucose (SMBG) and hypoglycemia. The questionnaire has recorded information about demographics, duration of diabetes, and treatment of diabetes, and hypoglycemia complications faced during Ramadan. The primary outcomes of this study include frequency of SMBG during fasting in Ramadan and association of SMBG and hypoglycemia and break of fasting. However, the secondary outcomes include medications, glycemic control, and other influencing factors. The data was analyzed using Statistical Package of Social Sciences (SPSS) version 20. Results: The findings have shown that the majority of the patients used a combination of metformin+sulphonylurea (23.02%) following metformin+insulin (20.86%), insulin (12.94%), and metformin (8.63%). Whereas diet control, high or low blood sugar, insulin dose adjustment in fasting conditions were the most influential factors during Ramadan when the blood sugar levels were tested. Majority of the patients monitored their blood glucose level during pre-iftar (56.8%) following to hypoglycemia (30.2%), post-iftar (29.4%), and rarely monitored in afternoon (3.5%) despite that only 10.1% monitored their blood glucose on a daily basis. Patients who had symptoms of hypoglycemia and had to break their fasting at least once were 41% and 27.2%, respectively. There is a significant association between age and gender with symptoms of low blood sugar level. Additionally, a significant association between blood sugar monitoring and high blood sugar level has been shown (p=0.041), indicating that lack in daily blood sugar monitoring can increase the blood sugar level of a patient during Ramadan. Conclusion: The present study has helped in providing better understanding about the selfmonitoring of blood glucose level and hypoglycemia. Furthermore, it also emphasizes the pre-Ramadan education about when to break their fasting along with frequency and timing of SMBG. Keywords: glycemic control, insulin, medication, metformin, sulphonylurea Introduction Correspondence: Deyaa Mansouri Hera General Hospital, Mecca, Saudi Arabia Email 1035 submit your manuscript | www.dovepress.com Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2020:13 1035–1041 DovePress © 2020 Mansouri et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://doi.org/10.2147/DMSO.S234675 Powered by TCPDF (www.tcpdf.org) The prevalence of diabetes has increased in recent decades at a massive rate, regardless of age groups. Developing countries have seen an increase in the prevalence of diabetes due to a variety of reasons; some of which are a sedentary lifestyle and poor-quality nutrition. It is expected to rise from about 415 million, to a burgeoning 642 million patients with Dovepress Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy downloaded from https://www.dovepress.com/ by 119.207.124.227 on 11-Jul-2020 For personal use only. Mansouri et al diabetes in the year 2040.1 In 2015, there were three Muslimmajority countries, Bangladesh, Indonesia, and Egypt, amongst the top 10 countries having adults suffering from diabetes.2 There is a widespread prevalence of obesity due to increasing wealth and westernization in the Arabian Gulf. Moreover, there is also an increase in the dietary consumption and energy-dense food. In addition, the adoption of a sedentary lifestyle with the least amount of exercise and physical activity have worsened the problem. Patients on a glucose control plan either for medical reasons or for religious reasons; like fasting in Ramadan, undergo a risk of suffering from hypoglycemia. Patients with diabetes must be very cautious when fasting during Ramadan as fasting can lead to low blood sugar; a condition known as hypoglycemia. Patients who insist on fasting, despite the risks associated with it, pose a medical challenge for the health-care professionals and for themselves.3 Delayed or missed meals and limited or no consumption of fluids vastly contribute to cause hypoglycemia. There are many other causes of hypoglycemia like, renal dysfunction, cognitive dysfunction, concomitant medications, old age, and long duration of diabetes.4 The main cause of hypoglycemia is the use of glucose-lowering medications that are used to increase the circulating insulin. The treatment of patients with type 2 diabetes with antihyperglycemic medications vastly increases the risk of hypoglycemia.5 Patients with diabetes who are at a high risk of major complications during fasting in Ramadan may face severe hypoglycemia. Moreover, patients undergoing dialysis treatment, performing intense physical labor, pregnant women, and patients with advanced macrovascular complications of the brain, heart, or peripheral vessels are recommended against fasting in Ramadan. Patients who are at moderate risk of complications during fasting, and insist on fasting, (...truncated)