The usage pattern of patients' drug information leaflet for oral non-prescription drugs among university students in the United Arab Emirates: cross-sectional study.

Background: Very few extensive studies have measured the prevalence and usage pattern of drug information leaflet (DIL) for oral non-prescription drugs (ONPDs) or identified the associated risk factors for not reading DIL among university students in the UAE. Objective: The current study aimed to estimate the prevalence of the usage pattern of DIL for ONPDs, and delineate the associated risk factors for not reading the DIL among university students. Methods: A cross-sectional survey-based multistage sampling technique conducted among 2875 students at three major universities in UAE. The self-administered validated questionnaire was constructed and developed based on Andersen's behavioral model. Binomial logistic regression performed to ascertain the effects of 25 potential predictors on the likelihood that participants not reading (discarded) the DIL after reading them. The primary outcome measure was reading (discarding without reading) the DIL, and the associated behaviours. Results: 2875 university students were eligible to participate in the study, but only 2519 students agreed to participate, indicating an 88% of intent participation. However, only 2,355 (81.9%) students completed the questionnaire. 1348 respondents reported using NPD (response rate 46.9%) during the past three months before conducting the study, which comprised the sample analysis (1307 were excluded). More than three-quarters of them read the DIL (always or often) at the first use (1049 of 1348, 77.8%). Approximately a quarter of those who read the DIL reported that they discarded them after reading (24.1%). The survey has identified four risk factors for not reading the DIL: those who get the drug information from physicians or pharmacists had lower odds of discarding the DIL (odds ration [OR] = 0.491, 95% confidence interval [CI]: 0.273-0.884, p value< 0.05). Medical students had lower odds of discarding the DIL (OR = 0.598, 95% CI: 0.412-0.868, p value< 0.05). Those participants who believe that NPDs are as effective as prescription drugs had lower odds of discarding the DIL (OR = 0.342, 95% CI: 0.123-0.948, p value< 0.05). Participants who use more than one NPD to treat a single symptom a day have higher odds of discarding the DIL (OR = 1.625, 95% CI: 1.122 -2.355, p value< 0.05). Conclusion: The prevalence of drug usage pattern in this population was 57.5% as 1348 subjects reported using NPD during the past 90 days before conducting the study. We have identified four risk factors for not reading the DIL, those who get the drug information from physicians or pharmacists, medical students, those respondents who believe that NPDs were as effective as prescription drugs, and respondents self-treating a single symptom with more than one NPD. It was evident from the findings that usage pattern of NPD for DIL varied among the students, with no specific pattern dominating.

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.

Patterns of Diabetes Care Among People with Type 1 Diabetes During Ramadan: An International Prospective Study (DAR-MENA T1DM).

INTRODUCTION: To describe the characteristics and care of participants with type 1 diabetes during Ramadan in the Middle East and North Africa. METHODS: The DAR-MENA (Diabetes and Ramadan-Middle East and North Africa) study was a prospective, observational study of adults with type 1 and type 2 diabetes who were Muslim and did/did not intend to fast during Ramadan 2016. Baseline data were collected 6 weeks prior to Ramadan, with a follow-up visit 1-2 months after Ramadan. This is the analysis of the population with type 1 diabetes. Measurements included proportion who fasted, reasons for fasting and not fasting, changes in diabetes treatment, hypoglycemic events, and proportion with access to diabetes education. RESULTS: Of 136 participants with type 1 diabetes, 76.9% (100/130) fasted for at least 1 day, 72.3% (94/130) fasted for at least 15 days, and 48.5% (63/130) fasted for 30 days. The majority (63.0%, 63/100) reported personal decision as a reason to fast. Fear of diabetic complications (58.6%, 17/29) and previous complications related to fasting (48.3%, 14/29) were the most common reasons for not fasting. Adjustment of diabetic medication regimen occurred for 84.6% (115/136) of participants, and 72.8% (99/136) changed their treatment dose. The incidence and number of adverse events for confirmed and severe hypoglycemia were similar before and during Ramadan. Almost half of participants had access to diabetes education (45.6%, 62/136). CONCLUSION: The DAR-MENA study showed that despite the risks associated with fasting for people with type 1 diabetes, almost half fasted for the full 30 days of Ramadan with no significant change in hypoglycemia events. Since the current International Diabetes Federation and Diabetes and Ramadan guidelines do not endorse fasting for people with type 1 diabetes, it is important that those who insist on fasting work closely with their healthcare practitioner to avoid any complications.

Safety of lixisenatide versus sulfonylurea added to basal insulin treatment in people with type 2 diabetes mellitus who elect to fast during Ramadan (LixiRam): An international, randomized, open-label trial.

AIMS: Adding lixisenatide to basal insulin (BI) instead of sulfonylurea (SU), versus continuing SU + BI was assessed in people with type 2 diabetes mellitus (T2DM) who intended to fast during Ramadan 2017. METHODS: LixiRam (NCT02941367) was a phase 4, randomized, open-label, 12-22-week study in people with T2DM insufficiently controlled with SU + BI ±â€¯1 oral anti-diabetic. Endpoints included the percentage of participants with ≥1 documented symptomatic hypoglycemia event (plasma glucose ≤70 mg/dL; primary endpoint) and any hypoglycemia during Ramadan fasting. RESULTS: A numerically lower percentage of participants with lixisenatide + BI (3.3%, 3/91) versus SU + BI (8.9%, 8/90) had ≥1 documented symptomatic hypoglycemia event (intent-to-treat visit 4) during Ramadan fasting (OR: 0.34; 95% CI 0.09, 1.35; proportion difference -0.06, 95% CI -0.13, 0.01); the difference was statistically significant for the 'any hypoglycemia' category (lixisenatide + BI: 4.3%, 4/92; SU + BI: 17.4%, 16/92; OR: 0.22; 95% CI 0.07, 0.68; proportion difference -0.13, 95% CI -0.22, -0.04; intent-to-treat). No new treatment-emergent adverse events occurred. CONCLUSIONS: Compared with SU + BI, lixisenatide + BI provided lower rates of any hypoglycemia in people with T2DM during Ramadan fasting. Lixisenatide + BI therapy may be a suitable treatment option during fasting.

Impact of Ramadan fasting on glucose levels in women with gestational diabetes mellitus treated with diet alone or diet plus metformin: a continuous glucose monitoring study.

OBJECTIVE: Women with gestational diabetes mellitus (GDM) are categorized as at high risk for adverse events during Ramadan fasting. However, this is largely based on clinical opinion. In this study, we shed some light on what happens to glucose levels during Ramadan fasting. METHODS: This is a prospective observational study. A total of 32 patients with GDM were recruited; 10 patients, treated with diet only (group 1), to observe their glucose levels before fasting and 22 patients who insisted on fasting the month of Ramadan, 13 treated with diet only (group 2) and nine treated with diet plus metformin 500 mg twice daily (group 3), to evaluate their glucose levels during fasting. Interstitial glucose was monitored in all by using the iPro2 Professional continuous glucose monitoring (CGM) system. RESULTS: Mean glucose level was 116±21 mg/dL (6.16±1.16 mmol/L), 106±9 mg/dL (5.88±0.49 mmol/L) and 99±7 mg/dL (5.49±0.34 mmol/L) in groups 1, 2 and 3, respectively. Patients in group 1 had the lowest rate of hypoglycemia (50%), followed by patients in group 2 (60%), whereas patients in group 3 had the highest rate of hypoglycemia (78%). CONCLUSIONS: CGM data indicates that Ramadan fasting in women with GDM treated with diet alone or with diet plus metformin was associated with lower mean glucose levels and higher rates of hypoglycemia when compared with non-fasting glucose levels. Women with GDM should be advised against fasting during Ramadan until further data is available.

A prospective multi-country observational trial to compare the incidences of diabetic ketoacidosis in the month of Ramadan, the preceding month, and the following month (DKAR international).

BACKGROUND: 1.7 billion Muslims worldwide obey divine commands of fasting for a month. This may increase the probability of the acute complications of diabetes during the fasting period. DESIGN AND METHODS: We primarily aimed to compare the incidences and duration of Diabetic ketoacidosis (DKA) admissions during Ramadan compared to the month before (Shaaban) and the month after (Shawal) as well as the average pre-Ramadan six months' admissions. Our secondary objective was to assess the different incidence of DKA between Ramadan and the other months regarding precipitating factors, fasting practices in people admitted with DKA and gender differences. This was a prospective study that included all Muslims who were admitted with DKA to major hospitals in the United Arab Emirates, Sudan, Tunisia and Morocco during the pre-Ramadan month, Ramadan and post-Ramadan month, in addition to the average monthly admissions during the last six months before Ramadan. Demographics, clinical, and laboratory indices were collected and analyzed to assess primary and secondary end points. RESULTS: One hundred seventy patients were admitted during the study duration, 56 were admitted during Ramadan and 63 in Shawal. Six months before Ramadan showed an average admission of 56 + 7 per month. All those admitted during Ramadan were people with type1 diabetes. 29.8 % of those admitted during Ramadan did not receive structured education program on diabetes management in Ramadan. Non-compliance to medications represented the commonest cause for admission in the whole study period. Hospital stay was comparable through different months, but the duration of acidosis was longest during Ramadan month. CONCLUSION: In concordance with DKAR1, DKAR international showed higher rates of DKA during Ramadan when compared to preceding Lunar month (Shaaban). In Shawal, however, the rates of DKA admission were higher than the average monthly DKA admissions. The duration of acidosis was longer in Ramadan group and positively correlated with duration of diabetes. Many patients did not receive structured education about diabetes and fasting Ramadan. Our study calls for formal pre-Ramadan education and enforces the need for advice against fasting in patients who already experienced DKA in the months preceding Ramadan.