COVID-19 research briefs: Updated recommendations on diabetes management during Ramadan and pandemic

Daily POEMs

Published: 2020-07-26 © 2020 John Wiley & Sons, Inc.

Clinical question
How should diabetes be managed in patients who choose to fast during Ramadan?

Bottom line
These expert-derived guidelines are updated from earlier recommendations for managing diabetes in Muslim patients who desire to fast during Ramadan. The updated guidelines focus on newer hypoglycemic agents and management during the COVID-19 pandemic. See the paper for more details. (LOE = 5)

Reference
Hanif S, Ali SN, Hassanein M, Khunti K, Hanif W. Managing people with diabetes fasting for Ramadan during the COVID-19 pandemic: A South Asian Health Foundation update. Diabetic Med 2020;37(7):1094-1102.

Study design: Practice guideline

Funding source: Foundation

Setting: Various (guideline)

Synopsis
Research brief #43: As an update to previous recommendations on management of diabetes during Ramadan, these authors urge that patients with type 1 diabetes not fast. Those choosing to do so should check their blood sugars at least 4 times each day, if not more often, and adjust insulin doses individually and very carefully. Fasting is only recommended for people with well-controlled type 2 diabetes (HbA1c < 7.5%; 59 - 69 mmol/mol) who use monotherapy and are otherwise healthy. All of the new classes of medications, including DPP-4 inhibitors, SGLT-2 inhibitors, and GLP-1 receptor agonists, are considered to carry a low risk of hypoglycemia; no reduction in dose is needed during fasting. Regardless of type of medication, patients are encouraged to avoid dehydration and not to fast if they have any symptoms of COVID-19 or recent exposure to individuals affected with COVID-19.

David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC

Copyright © 2020 John Wiley & Sons, Inc.