Impact of Ramadan-focused diabetes education on hypoglycemia risk and metabolic control for patients with type 2 diabetes mellitus: A systematic review.

BACKGROUND: Ramadan fasting is regarded as a form of worship amongst Muslims. However, patients with a high risk of diabetic complications are advised to avoid fasting, as the practice is associated with significant impacts on several health factors for type 2 diabetic patients, including glycaemic control. Thus, a lack of focused education before Ramadan may result in negative health outcomes. AIM: To evaluate the impact of a Ramadan-focused diabetes education programme on hypoglycaemic risk and other clinical and metabolic parameters. METHODS: A systematic literature search was performed using Scopus, PubMed, Embase, and Google Scholar to identify relevant studies meeting the inclusion criteria from inception. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and guidelines were followed when performing the search and identification of appropriate studies. RESULTS: Seventeen studies were included in this systemic review; five of them met the criteria to compile for a meta-analysis. The included studies were with various study designs, including randomised controlled trials, quasi-experimental and non-randomised studies. Overall, the results revealed a significant reduction of hypoglycemia risk (81% reduction) for fasting patients in intervention groups who received Ramadan-focused education compared with patients receiving conventional care (OR 0.19, 95% CI: 0.08-0.46). Moreover, HbA1c significantly improved amongst patients who received a Ramadan-focused diabetes education intervention, compared with those receiving conventional care. CONCLUSION: Ramadan-focused diabetes education had a significant impact on hypoglycemia and glycaemic control, with no significant effect on body weight, blood lipids or blood pressure.

Incidence and risk factors associated with hypoglycemia among patients with chronic kidney disease: A systematic review.

Hypoglycemia is a common complication in patients with chronic kidney disease (CKD), more so if they have diabetes as well. The occurrence of hypoglycemia in CKD is associated with considerable morbidity and mortality, both of which are treatable and preventable. This review summarizes the incidence and risk factors associated with hypoglycemia among patients with CKD. The meta-analysis was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A search was done on PubMed, EMBASE, SCOPUS, Cochrane Library, Google Scholar, and Cumulative Index to Nursing and Allied Health Literature for cohort studies in English published between January 2000 and August 2019 using search terms related to hypoglycemia (low blood sugar), chronic kidney disease (chronic renal failure OR renal failure), and incidence (risk OR epidemiology OR risk factors). Summary measures were calculated using random-effects model. A total of 5 studies involving 311,817 persons were included in the meta-analysis. The pooled incidence of hypoglycemia in patients with CKD was 0.188 (confidence interval [CI] = 0.097-0.287). The incidence of hypoglycemia was significantly higher in patients with CKD than in patients without CKD (Relative risk [RR] = 1.89, 95% CI = 1.86-1.92, P < 0.0001). No heterogeneity was reported between the studies (I2 = 0%, P > 0.05), and publication bias was also found. Females, patients who had diabetes mellitus of long duration, and those on antidiabetic drugs such as insulin and sulfonylureas were at risk of developing hypoglycemia in CKD as per narrative review. The incidence of hypoglycemia in patients with CKD is high. Therefore, there is need to closely monitor affected individuals so that appropriate management protocols could be set up. Further probing of various risk factors for hypoglycemia in CKD patients is necessary for early detection and initiation of timely preventive and curative measures.