title: Ramadan fasting with diabetes: an interview study of inpatients' and general practitioners' attitudes in the South of France.
abstract: OBJECTIVE
  The aim of this study was to evaluate attitudes in hospital inpatients and physicians towards Ramadan fasting and diabetes in Marseille.
  
  
  METHODS
  This cross-sectional study was conducted during the three months prior to the month of Ramadan. A total of 101 patients (age: 57±17 years) and 101 general practitioners (GPs) were recruited into the study.
  
  
  RESULTS
  The patients had low levels of education (52% illiteracy). Of the 101 patients, 52 continued to fast during Ramadan, and only 65 patients had discussed the matter with their GP. Of these, 36 were told that fasting was forbidden, but more than half (n=19) fasted despite the medical advice. Six patients thus experienced daily hypoglycaemia because they had continued to take their hypoglycaemic agent or insulin analogue at noon. Both inadequate education and religious attitudes were found to endanger patients during the fast: 15 patients skipped the meal scheduled before dawn, five of whom persisted in taking their sulphonylurea. Also, 27% of patients refused, in spite of daytime hypoglycaemia, to ingest anything orally to avoid breaking their fast. Among the GP population, medical knowledge of Ramadan fasting with diabetes was low, leading to medically unjustified negative advice for fasting and a lack of patient education on adjusting treatments. This particular situation weakened the patient-physician relationship.
  
  
  CONCLUSIONS
  This study confirms the importance of Ramadan fasting for Muslim patients, and reveals a wide cross-cultural gap between GPs and their patients. Systematic advice on treatment adjustment needs to be given. For this reason, we encourage more sensitive care of these patients and more medical training for physicians.
authors.affiliation: Department of Endocrinology, Diabetes and Nutrition Department, Hôpital Nord, Chemin des Bourrely, 13015 Marseille, France. benedicte.gaborit@ap-hm.fr
authors.forename: B
authors.initials: B
authors.lastname: Gaborit
authors.forename: O
authors.initials: O
authors.lastname: Dutour
authors.forename: O
authors.initials: O
authors.lastname: Ronsin
authors.forename: C
authors.initials: C
authors.lastname: Atlan
authors.forename: P
authors.initials: P
authors.lastname: Darmon
authors.forename: R
authors.initials: R
authors.lastname: Gharsalli
authors.forename: V
authors.initials: V
authors.lastname: Pradel
authors.forename: F
authors.initials: F
authors.lastname: Dadoun
authors.forename: A
authors.initials: A
authors.lastname: Dutour
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000178:diet therapy / Q000208:ethnology / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy / Q000208:ethnology / Q000523:psychology*; D005215:Fasting / Q000009:adverse effects / Q000523:psychology*; D005260:Female; D005602:France / Q000453:epidemiology; D058005:General Practitioners / Q000523:psychology / Q000706:statistics & numerical data; D006693:Holidays / Q000523:psychology*; D006801:Humans; D007297:Inpatients / Q000523:psychology / Q000706:statistics & numerical data; D007514:Islam / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D011795:Surveys and Questionnaires