Effect of Different Insulin Regimens on Individuals with Type 2 Diabetes during Ramadan Fasting in the DAR Global Surveys of 2020 and 2022

Mohamed Hassanein; Khadija Hafidh; Muhammad Yakoob Ahmedani; Samih A. Odhaib; Inass Shaltout; Mohammed A. Batais; Rulli Rosandi; Mohamed Fariduddin; Majid Alabbood; Mehmet A. Buyukbese; Tong C. Voon; Rachid Malek; Reem Al-Amoudi; Abdulla Alzahrani; Zanariah Hussein

doi:10.1055/s-0045-1811580

Journal of Diabetes and Endocrine Practice, Inhaltsverzeichnis

CC BY 4.0 · Journal of Diabetes and Endocrine Practice
DOI: 10.1055/s-0045-1811580

Original Article

Effect of Different Insulin Regimens on Individuals with Type 2 Diabetes during Ramadan Fasting in the DAR Global Surveys of 2020 and 2022

Authors

Mohamed Hassanein

¹Department of Diabetes and Endocrinology, Dubai Hospital, Dubai Academic Health Corporation, Dubai, United Arab Emirates

²Department of Medicine, Gulf Medical University, Ajman, United Arab Emirates

³Postgraduate Diabetes Education, Cardiff University, Cardiff, United Kingdom
Khadija Hafidh

⁴Diabetes Unit, Rashid Hospital, Dubai Academic Health Corporation, Mohamed Bin Rashid University (College of Medicine and Health Sciences), Dubai, United Arab Emirates
Muhammad Yakoob Ahmedani

⁵Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan
Samih A. Odhaib

⁶Faiha Specialized Diabetes, Endocrine, and Metabolism Center, University of Basrah, Basrah, Iraq
Inass Shaltout

⁷Department of Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
Mohammed A. Batais

⁸Diabetes and Chronic Disease Management, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
Rulli Rosandi

⁹Internal Medicine Department, Fakultas Kedokteran Universitas Brawijaya, Dr. Saiful Anwar Hospital, Indonesia
Mohamed Fariduddin

¹⁰Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
Majid Alabbood

¹¹Department of Medicine, Gold Coast University Hospital, Queensland, Australia
Mehmet A. Buyukbese

¹²Gaziantep Islam Science and Technology University, Gaziantep, Turkiye
Tong C. Voon

¹³Department of Medicine, Malacca General Hospital, Malacca, Malaysia
Rachid Malek

¹⁴Service Médecine Interne, CHU Sétif, Algeria
Reem Al-Amoudi

¹⁵Endocrine Department, King Abdul-Aziz Medical City, King Saud Bin Abdulaziz University, Riyadh, Saudi Arabia
Abdulla Alzahrani

¹⁶Endocrine Department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Zanariah Hussein

¹⁷Department of Internal Medicine, Hospital Putrajaya, Putrajaya, Malaysia

Abstract

Introduction

The DAR (Diabetes and Ramadan International Alliance) global surveys of 2020 and 2022 presented a unique opportunity to study the differences among various insulin treatment regimens during Ramadan fasting in individuals with diabetes to better understand the risks and complications associated with insulin therapy between the different regimens.

Patients and Methods

Individuals with type 2 diabetes on an intensive insulin regimen were categorized into two cohorts: 1,527 receiving basal-bolus insulin (14.1%) and 1,355 on premixed insulin (12%). We examined the patterns of differences between the two cohorts concerning baseline characteristics, diabetes-related complications, dysglycemia occurrence, and hospitalization rates during fasting.

Results

The mean age was similar between cohorts (56.0 ± 12.1 years in basal-bolus vs. 55.1 ± 11.3 years in premixed insulin). However, the basal-bolus group had a significantly longer diabetes duration (14.1 ± 8.4 vs. 12.5 ± 7.5 years, p = 0.03). Other metabolic parameters, including HbA1c, body mass index, blood pressure, and low-density lipoprotein cholesterol levels were not different. Insulin use was slightly higher in women in both groups. Proportions of those who fasted, practiced self-monitoring of blood glucose, and had access to Ramadan-focused education were similar in the two cohorts. The basal-bolus cohort had tended to have increased occurrence of hypoglycemic episodes (23.9% vs. 17.7%, p = 0.08) but similar rates of hypoglycemia (6.5%). Frequent hyperglycemia (≥8 days) and the hyperglycemia-related emergency visits and hospitalizations were significantly higher in the basal-bolus group (9.0% vs. 3.7%, p < 0.001).

Conclusion

Multiple-dose premixed insulin regimens in this study appear less prone to hyperglycemic episodes and hospitalizations. However, a causal relationship cannot be inferred as differences and variations in medical management, prescribing habits, and fasting practices across wider regions must be considered confounding factors. Carefully designed randomized-controlled studies are needed to establish a definitive link.

Keywords

Ramadan fasting - type 2 diabetes - insulin regimen - basal-bolus - premixed insulin

Volltext

Referenzen

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