RESUMEN
Fasting during the holy month of Ramadan is obligatory for all healthy adult and adolescent Muslims from the age of 12 years. This involves abstaining from eating or drinking from early dawn (Suhur/Sehri) till sunset (Iftar).Fasting is not meant to create excessive hardships or impart any adverse effect to the Muslim individual. As such, Islam has exempted certain categories of people from fasting including young children, travelers, the sick, the elderly,and pregnant and lactating women. According to expert opinion, people with type 1 diabetes who fast during Ramadan are at very high risk of metabolic deterioration. However, some recent studies have demonstrated that individuals with type 1 diabetes who are otherwise healthy and stable, can fast during Ramadan provided they comply with the Ramadan focused management plan and are under close professional supervision. This article discusses how to assess, counsel, monitor and manage people with type 1 diabetes who wish to fast during Ramadan.
RESUMEN
BACKGROUND: Fasting (Sawm) during Ramadan, one of the five pillars of Islam is obligatory for all healthy adult and adolescent Muslims from the age of 12 years. Some children with diabetes, despite their exemption insist on fasting in Ramadan. We evaluated the safety of fasting among children with type 1 diabetes. MATERIALS AND MATHODS: A prospective observational study was designed for diabetic children and adolescents who wish to fast during Ramadan 2012. Patients with their caregivers were given intensive education and instructions were provided by diabetic educators, dieticians and physicians on insulin adjustment, home blood glucose monitoring and dietary adjustments prior to Ramadan. RESULTS: A total of 33 children and adolescents were included in this study. Of these, 16 were male and 17 were female. Majority (60.6%) of the patients could complete their fasting during the Ramadan. Patients were divided into two groups, those who completed fasting were considered as Group-I, whereas patients who broke the fast were in Group-ll. Blood glucose, hemoglobin A1c weight, and insulin dose before and after Ramadan in two groups showed no significant difference. CONCLUSION: Children older than 11 years of age with type 1 diabetes mellitus with conventional twice-a-day regimen can fast safely during Ramadan provided they have proper education and intensive follow-up during Ramadan.
RESUMEN
Although prospective studies suggest that low selenium is a risk factor for cardiovascular disease, most clinical trials of selenium supplementation have not shown this benefit. Prospective studies of renal insufficiency show that it is associated with low-selenium levels, and increased cardiovascular disease risk. We hypothesized that low selenium and renal insufficiency might show biologically important interactions warranting a future trial of selenium supplementation in this high-risk group of patients with both renal insufficiency and low selenium. We evaluated the prospective association of low selenium and renal insufficiency with coronary heart disease and all-cause mortality. A cohort of 10,531 NHANES III participants aged 35 years or older with serum selenium measurements and creatinine were followed longitudinally and linked to the National Death Index. In multivariable-adjusted analysis, low-selenium levels were associated with an increased risk of CHD mortality (HR=1.26; 95% CI: 0.94-1.69) and an increased risk for all-cause mortality (HR=1.41; 95% CI: 1.18-1.68). Renal insufficiency was also associated with increased risk of CHD mortality (HR=1.64; 95% CI: 1.29-2.08) and all-cause mortality (HR=1.51; 95% CI: 1.31-1.74). Despite the findings that adults with impaired renal function and low selenium had an increased risk for CHD mortality (HR=2.06; 95% CI: 1.13-3.75), there was no evidence of supra-additivity between low selenium and renal insufficiency on rate of CHD mortality (relative excess risk due to the interaction [RERI=0.16; 95% CI: -1.34 to 1.65] or all-cause mortality (RERI=-0.85; 95% CI: -1.50 to -0.20). This analysis suggests that the combination of renal insufficiency and low selenium does not represent an extremely high-risk group where a randomized trial of selenium supplementation would be of greater value than focusing on all adults with low-serum selenium.