RESUMEN
Purpose: Impact of ramadan fasting on healthy and women with diabetes is already known. However, there is a scarcity of data on impact of fasting on pregnant women with diabetes. Moreover, religious and medical recommendations advise pregnant women against fasting as it is unsafe. Despite being exempted, many pregnant Muslim women with diabetes still choose to fast during ramadan. This study investigated different glycemic marker as an indicator for diabetes control in fasting pregnant women. Patients and Methods: This is a prospective observational study. A total of 89 pregnant diabetes women were recruited. Blood glucose was self-monitored in all the pregnant women using glucose monitoring device at home. We measure the fructosamine, HbA1c levels before, during and after ramadan. Results: Pregnant women with type 1 diabetes were 14 (25%), type 2 diabetes were 21 (37.5%), and gestational diabetes were 21 (37.5%). The mean fructosamine level decreased during and after ramadan in gestation diabetes pregnant women compared to type 2 diabetes and type 1 diabetes pregnant women subjects (p = 0.009). Conclusion: The present study indicates that pregnant women with diabetes were able to fast during ramadan and there fructosamine level reduced during fasting. Utilization of fructosamine for short-term monitoring of glycemic control in addition to home glucose monitoring in pregnant women with diabetes will provide a good index of glycemic control. Recommendation: Religious and medical recommendations advise pregnant women against fasting as it is unsafe, and they are under high risk. However, if they insist to do fast, they must do under strict medical supervision and fructosamine can be used as a glycemic control marker.
RESUMEN
More than 50 million Muslims throughout the world with type 2 diabetes mellitus (T2DM) fast for one lunar month (Ramadan) each year. Health care providers within and outside the Muslim world need to be aware of the nature of these partial days of fasting and their risks (and potential benefits) to people with T2DM, and need to provide Ramadan-adjusted diabetes care. Hypoglycemia during the fasting days represents the greatest health risk for these patients; hence, diabetes-related pharmacotherapy needs to be tailored and adjusted with this risk in mind. With limited trial data available, this review proposes practical modifications to the usual pre-Ramadan antidiabetic regimens that are based on pathophysiological principles, clinical trial evidence (where available), expert opinion, and extended practical experience. Individualization of care is paramount in this regard to take into consideration the patient and societal, cultural, and economic variables.