Attitude and safety of patients with diabetes observing the Ramadan fast.

AIMS: To describe the attitude of type 2 diabetes patients toward Ramadan fasting. A Secondary purpose was to describe rates of hypoglycemia during Ramadan according to type of treatment. METHODS: A prospective, non-randomized study for 2 years. Participants with type 2 diabetes attending Dammam Diabetes Center, Saudi Arabia were stratified for fasting according to ADA recommendations. Results are presented using mean, standard deviation and percentages. RESULTS: Total of 360 participants with type 2 diabetes. Mean ±â€¯SD glycosylated hemoglobin was 8.9 ±â€¯2.1. More than 80% of individuals were in the ADA higher risk group however, they all fasted Ramadan. The mean non-fasting days was 2.6 days and overall rate of hypoglycaemia was 24.7%. Both parameters were directly proportionate to the risk stratification level (P-value <0.05). Despite hypoglycaemia, 29.3% continued fasting. Hypoglycemia was highest in patients treated with insulin (P-value <0.05) followed by those treated with oral agents including sulphonylurea as compared to oral agents excluding sulfonylurea (P-value = 0.002). Those who experienced hypoglycemia prior to Ramadan had the highest rate of hypoglycemia during Ramadan (53.3%) (P-value = 0.0065). CONCLUSIONS: Despite medical advice, the vast majority of type 2 diabetes participants categorized as high risk, fasted Ramadan. Approximately one quarter of people with type 2 diabetes in our cohort experience hypoglycaemia and this was directly related to their fasting risk level. A sizeable proportion continued the fast despite hypoglycemic. Insulin therapy with or without oral agents and previous episodes of hypoglycemia before Ramadan predicted hypoglycemia risk during Ramadan. HbA1c and weight showed some clinical improvements post Ramadan fasting. This is a single center study of mostly high risk fasting patients and hence, these results should not be generalized.

Closing Gaps in Diabetes Care: From Evidence to Practice.

BACKGROUND: Tracking progress in diabetes care may help in evaluating the quality of efforts and identifying gaps in the care. OBJECTIVES: To demonstrate that tracking important clinical indicators of diabetes mellitus can result in improved care as well as help identify and close gaps between evidence and practice in diabetes care. SUBJECTS AND METHODS: The study is an observational, random audit of medical records of patients with diabetes who received care at the Diabetes Center, Dammam Medical Complex. Thirteen process and four outcome key performance indicators were studied using the quality improvement Plan-Do-Study-Act model, for the period between October 2012 and March 2016. Individual physician performance was also measured for the same duration. All data were benchmarked against peer organizations worldwide. RESULTS: Urine examination for proteinuria, foot examination, annual influenza vaccination, aspirin prescription, structured education, personalized nutritional advice and self-monitoring of blood glucose significantly improved between baseline and the final observation of the study (P < 0.001). The proportion of patients with hemoglobin A1c >9% decreased, and that of those who achieved the recommended levels of hemoglobin A1c (<7%), low-density lipoprotein cholesterol (<2.6 mmol/L) and blood pressure (<140/90 mmHg) significantly increased (P < 0.001). Benchmarking against peer organizations worldwide showed comparable results overall, and better results for certain indicators. CONCLUSION: Quality improvement strategies and key performance indicators can be utilized to improve the quality of diabetes care delivered, and thus reduce gaps and barriers that exist between recommended diabetes care and practice.