title: Implementation of Ramadan-specific diabetes management recommendations: a multi-centered prospective study from Pakistan.
abstract: BACKGROUND
  To observe the outcome of implementation of Ramadan-specific diabetes management recommendations in fasting individuals with diabetes through health care providers.
  
  
  METHODS
  This multi-centered prospective study was conducted at nine diabetes specialist centers in four provinces of Pakistan. The study was carried out in two phases; pre-Ramadan recruitment interview (visit A) and post-Ramadan follow up interview (visit B) of the same patients. Pre-Ramadan individual counseling was given and educational material provided to each patient by health care providers during visit A.
  
  
  RESULTS
  Out of 388 patients with diabetes, blood glucose level was checked by all patients with type 1 and 71.43% patients with type 2 diabetes when they developed hypoglycemic symptoms during Ramadan. Of patients with type 1 and type 2 diabetes, 33.33% and 48% discontinued their fast when they felt hypoglycemic symptoms, respectively. None of the patient with type 1, while 18.87% patients with type 2 diabetes discontinued fast on the development of hyperglycemic symptoms. Drug dosage and timing were altered in 80% patients with type 1 and 90.5% patients with type 2 diabetes during Ramadan. Majority of the patients with type 2 diabetes changed from moderate/severe levels of physical activity before Ramadan to light physical activity during Ramadan (p<0.000). None of the patients required hospitalization when they developed symptomatic hypoglycemia or hyperglycemia and none developed diabetic ketoacidosis and hyperglycemic hyperosmolar state during Ramadan.
  
  
  CONCLUSIONS
  We observed that it is practicable to implement Ramadan-specific diabetes management recommendations through health care providers.
authors.affiliation: Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan. myakoob@bideonline.com.
authors.forename: Muhammad Yakoob
authors.initials: MY
authors.lastname: Ahmedani
authors.forename: Syed Faraz Danish
authors.initials: SF
authors.lastname: Alvi
authors.forename: Muhammad Saif Ul
authors.initials: MS
authors.lastname: Haque
authors.forename: Asher
authors.initials: A
authors.lastname: Fawwad
authors.forename: Abdul
authors.initials: A
authors.lastname: Basit