Effect of Fasting Ramadan in Diabetes Control Status - Application of Extensive Diabetes Education, Serum Creatinine with HbA1c Statistical ANOVA and Regression Models to Prevent Hypoglycemia

Kamran   M.A.   Aziz

Abstract

Ramadan fasting is an obligatory duty for Muslims. Unique physiologic and metabolic changes occur during fasting which requires adjustments of diabetes medications. Although challenging, successful fasting can be accomplished if pre-Ramadan extensive education is provided to the patients. Current research was conducted to study effective Ramadan fasting with different OHAs/insulins without significant risk of hypoglycemia in terms of HbA1c reductions after Ramadan. ANOVA model was used to assess HbA1c levels among different education statuses. Serum creatinine was used to measure renal functions. Pre-Ramadan diabetes education with alteration of therapy and dosage adjustments for OHAs/insulin was done. Regression models for HbA1c before Ramadan with FBS before sunset were also synthesized as a tool to prevent hypoglycemia and successful Ramadan fasting in future. Out of 1046 patients, 998 patients fasted successfully without any episodes of hypoglycemia. 48 patients (4.58%) experienced hypoglycemia. Χ² Test for CRD/CKD with hypoglycemia was also significant (p-value < 0.001). Significant associations and linear regression were found for HbA1c and sunset FBS; RBS post-dawn with RBS mid-day and FBS at sunset. The proposed regression models of this study can be used as a guide in future for Ramadan diabetes management. Some relevant patents are also outlined in this paper.

Keywords: ANOVA, CRD/CKD, creatinine, diabetes, hypoglycemia, insulin, OHA, Ramadan, regression, SMBG.