The effect of COVID-19 on Ramadan fasting in people with diabetes in East London 2020: The East London diabetes in Ramadan survey.

AIMS: Fasting during the COVID-19 crisis was challenging for Muslim people with diabetes during Ramadan. We aimed to survey the experiences of patients with Type 2 diabetes (T2D) during Ramadan 2020. METHODS: Telephone survey of Muslim patients with T2D in Tower Hamlets, London. Patients were surveyed on the effects of COVID-19 on their fast, discussions with a healthcare professional (HCP) before Ramadan, whether they followed advice, number of fasts undertaken, medication changes and adverse events. RESULTS: 829 participated. 334 (40.2%) discussed fasting with a HCP; 198 (59.3%) were advised not to fast; 171 (86.3%) elected not to fast. 12 (1.4%) were admitted to hospital during Ramadan - one fasting related severe hypoglycaemia, one non-fasting cerebrovascular accident, and 10 (four fasting and six non-fasting) with COVID-19 symptoms. 34 (8.2%) patients in the fasting group developed COVID-19 symptoms before or during Ramadan; 30 (7.2%) in the non-fasting cohort. 311 (37.5%) patients said COVID-19 had significantly influenced their decision not to fast. Compared to Ramadan 2016, in Ramadan 2020 fewer people fasted (50.1% vs 55.4%), fewer people discussed fasting with a HCP (40.2% vs 52%), more patients who discussed fasting with their HCP were advised not to fast (59.3% vs 33.8%), and fewer patients fasted against medical advice (13.7% vs. 19.3%). CONCLUSIONS: COVID-19 had an impact on people with diabetes and their fasting intentions during Ramadan 2020. Most people who were advised not to fast did not fast; there were few adverse outcomes from fasting. COVID-19 was not more common amongst people who fasted.

Fasting outcomes in people with diabetes and chronic kidney disease in East London during Ramadan 2018: The East London diabetes in Ramadan survey.

OBJECTIVES: Fasting in summer months for Muslim people with diabetes during Ramadan is challenging, particularly in temperate climates, where duration of fasting is prolonged. Risk of fasting may be greater in people with diabetes and chronic kidney disease (CKD). We aimed to prospectively monitor the outcomes of patients with diabetes and CKD stage 3 during Ramadan 2018 in East London. METHODS: Patients with type 2 diabetes (T2D) and CKD stage 3 attending community diabetes clinics were approached prior to Ramadan 2018 to discuss fasting. Patients were risk categorised according to Diabetes and Ramadan Alliance guidelines. If they chose to fast, Ramadan education was given, and biomedical assessments were undertaken within one week prior to and one week after fasting. Outcomes between patients fasting and non-fasting groups were compared. RESULTS: Fasting (n = 68) and non-fasting groups (n = 71) were similar apart from slightly higher insulin use in the non-fasting group. Median days fasted was 21 (range 12-29). There were no significant changes in weight, blood pressure, creatinine, glycated haemoglobin, cholesterol and urinary PCR pre- and post-Ramadan, and no significant differences between the fasting and non-fasting groups. There was no difference in adverse events (acute kidney injury, hypoglycaemia or cardiovascular events) between the fasting and non-fasting groups. CONCLUSIONS: No significant differences were seen in clinical or biochemical parameters, or adverse events between fasting and non-fasting patients. Patients with T2D and stable CKD stage 3 may be able to fast safely during Ramadan.

Exploring reasons for very poor glycaemic control in patients with Type 2 diabetes.

AIM: The aim was to determine prevalence and reasons for very poor glycaemic control (HbA1c≥10% [86 mmol/mol]) amongst people with Type 2 diabetes in an ethnically diverse urban population. METHODS: Databases of three primary health centres were searched for patients with Type 2 diabetes ≥1 year, most recent HbA1c≥10% [86 mmol/mol]. Patients were invited to explore reasons for poor glycaemic control and develop an individualised management plan. Review of glycaemic control was undertaken at 6 months. RESULTS: Of a total population of 28,677, 1261 had Type 2 diabetes (4.4%). 143 (11.3%) had last recorded HbA1c≥10% [86 mmol/mol]; 128 were reviewed (46.9% South Asian). People with poorer control had longer duration of diabetes and more South Asian ethnicity. Reasons for poor glycaemic control were: THERAPY: lack of titration of tablets (7.8%) or insulin (12.5%), poor concordance with medication (14.0%), insulin refusal (11.7%), side effects (16.4%); Engagement: poor concordance with lifestyle (26.5%), lack of knowledge of diabetes (14.0%), infrequent attendance at clinic (16.4%); Psychosocial/mental health: denial that diabetes was a problem (7.0%), mental health problem (9.4%), social issues (10.9%); Occupation: refusal of insulin due to occupation (1.6%); difficulty in attending reviews (5.5%). At six month review, 54.5% of patients had improved HbA1c≥1%. CONCLUSIONS: Poor control affects 1 in 10 of our population. We have determined a number of factors which may explain most causes. Individualised management using care planning can significantly improve control.

Changing pattern of referral to a diabetes clinic following implementation of the new UK GP contract.

BACKGROUND: The aim of this study was to determine the impact of the new GMS contract on referral patterns to a secondary care diabetes clinic. All new patient referrals received from primary care to a hospital diabetes service were surveyed. No significant change in referrals was seen 6 months after implementation of the GMS contract. There was, however, an increase in referrals for poor glycaemic control after implementation of the new GMS contract, and the glycaemic threshold for referral with poor glycaemic control has reduced (9.7% versus 10.6%, P = 0.006, mean difference = 0.9% [95% confidence interval = 0.4 to 1.3%]).

Are spouses of patients with type 2 diabetes at increased risk of developing diabetes?

OBJECTIVE: To determine whether spouses of patients with type 2 diabetes have an increased risk of diabetes compared with spouses of subjects with normal glucose tolerance. RESEARCH DESIGN AND METHODS: A random sample of spouses of patients with type 2 diabetes (group 1S) attending a general practice diabetes clinic was compared with spouses of nondiabetic subjects (as determined by oral glucose tolerance test [OGTT]) (group 2S). Spouses in both groups underwent OGTT, fasting lipid profile, and blood pressure (BP) measurements. RESULTS: A total of 245 subjects in group 1S and 234 subjects in group 2S underwent OGTT. Group 1S had a significantly higher incidence of fasting glucose, impaired glucose tolerance, or type 2 diabetes (19.1 vs. 9.4%). Group 1S also had higher fasting glucose and triglyceride levels, higher BMI, and a trend toward higher BP. Multivariate logistic regression analysis, adjusted for BMI and age, showed the risk of diabetes in the spouse of a patient with diabetes was 2.11 (95% CI 1.74-5.1), as compared with the spouse of a subject with normal glucose tolerance. Similarly, the risk of any degree of glucose intolerance in a spouse of a patient with type 2 diabetes was 2.32 (1.87-3.98), as compared with a spouse of a subject with normal glucose tolerance. CONCLUSIONS: Spouses of patients with type 2 diabetes have a significantly increased risk of glucose intolerance and type 2 diabetes, and they should be classified as high risk for diabetes. This finding has implications for screening programs, which should include spouses of subjects with diabetes.