3 May 2018

Bridget Benelam
Nutrition Communications Manager

Ramadan 2018 starts around May 15th and this year in the UK, fasts will last from about 3am in the morning until about 9pm at night, resulting in big changes to daily eating, drinking and sleeping patterns.

In my experience, non-Muslims tend to focus on the challenges of going without foods and drinks during the daily fasts (“Really, you can’t even have water?”). But Muslims look forward to Ramadan as a deeply spiritual period, where time is spent with family, friends and community and where we try to behave well towards others, a bit like the ‘Peace and goodwill to all’ ethos around Christmas time. This is why the question of whether or not to fast becomes so important. While the Quran provides exemptions for those who are ill or whose health could be affected by fasting, this may not be seen as an easy option but as being excluded from an important act of faith and from the communal aspects of the fast.

This is particularly important in the case of diabetes - there are estimated to be 325,000  UK Muslims with diabetes and people from a South Asian ethnic background including Pakistani and Bangladeshi, are at increased risk. This may mean that living with diabetes is considered quite ‘normal’ within these communities and many will fast, even if advised not to do so. A study that looked at views in a group of British Muslims with diabetes found that many would not consult a health professional before fasting as they thought they would be told not to fast or that their GP or practice nurse would not understand the significance of fasting.

With long periods without food or fluids during the daily fasts, people with diabetes may be at greater risk of both hypo and hyper glycaemia (blood glucose being too low or too high), diabetic ketoacidosis (caused by high levels of ketones in the blood), dehydration and thrombosis.

So how can health professionals support Muslims with diabetes if they choose to fast for Ramadan?

Although there has not been a great deal of research in this area the Ramadan Education and Awareness in Diabetes (READ) study looked at the impact of providing an education programme for Muslims with type 2 diabetes who fast in Ramadan. The intervention group (57 people) were given a two-hour training session by a specialist dietitian and nurse practitioner which included information on meal planning, physical activity, glucose monitoring, hypoglycaemia, dosage and timing of medication. The control group (54 people) had been invited to join the programme but did not attend and so did not receive any information before Ramadan.

Hypoglycaemic events and body weight were measured the month before and during Ramadan. There were 9 hypoglycaemic events in both groups in the month before Ramadan. Interestingly this decreased to 5 during Ramadan in the group who received the READ programme, compared to 36 such events during Ramadan in the control group. In addition, the group that received the READ programme lost 0.7kg on average during Ramadan, compared to an average weight gain of 0.6kg in the control group. Intervention may be important in the longer term as well. HbA1c (a measure that gives an indication of blood sugar levels over the longer term) was measured at the start of the study and then 12 months after. In the group who received the READ programme, there was no increase in HbA1c, versus an increase of 0.33% in the control group. While this may not sound much, it’s been estimated that a 1% increase in HbA1c concentration is associated with an increase of about 30% in all-cause mortality and 40% in cardiovascular disease mortality, among individuals with diabetes and so this may an important change.

While this is only one, fairly small study, it does suggest that even one short educational intervention before Ramadan could have significant benefits for Muslims with diabetes who choose to fast and this could be a key opportunity for health professionals to have a positive impact on their patients. However, in order to provide this support, we need to ensure that Muslims with diabetes are willing to engage with health professionals to talk about fasting and that health professionals themselves have a better understanding of the significance Ramadan fasting may have.

For more information about Ramadan and Diabetes:

A healthy Ramadan

International Diabetes Federation and the Diabetes and Ramadan International Alliance practical guidelines for health professionals

Ramadan and diabetes – Diabetes UK

Ramadan Education and Awareness in Diabetes (READ) programme for Muslims with Type 2 diabetes who fast during Ramadan.

Having diabetes and having to fast: a qualitative study of British Muslims with diabetes