title: Diabetes during Ramadan - PRE-approach model: presentation, risk stratification, education.
abstract: OBJECTIVE
  Fasting (Sawm) during Ramadan is one of the five pillars of Islam and mandatory for all Muslim healthy adults. Most of the Muslim diabetic patients insist on fasting in Ramadan despite their exemption. Due to paucity of literature, diabetes during Ramadan is underestimated and the statistics are not reflecting the actual reality. The aim of this study is to highlight the demographics in diabetic Muslim population and emphasize its ramifications on Ramadan fasting.
  
  
  METHODS
  In this study, we developed a 3 step PRE-approach model based on Presentation, Risk stratification, Education in diabetics who fast during Ramadan. For the establishment of this model we identified 40 published studies in database searches including ISI-web of science and pub-med. We searched the related literature by using the key words including diabetes mellitus, Ramadan fasting. All studies in which diabetes and fasting in Ramadan was investigated were included. There was no limitation on publication status, design or language. Finally, we included 35 publications and remaining 5 were excluded from the study.
  
  
  RESULTS
  The diabetic patients who fast are at risk of severe hypoglycemia, hyperglycemia, diabetic ketoacidosis, dehydration, thrombosis, strokes and retinal artery occlusion. Lack of education, poor healthcare and no structured guidance cause adeverse health consequences.
  
  
  CONCLUSIONS
  It is vital to empower the healthcare workers and the patients in the frontlines with appropriate information. To preempt and minimize the problems faced by the diabetic patients who fast, available resources should be mobilized to efficiently and effectively reach out these patients. Diabetic patient educational guidelines about Ramadan fasting should be disseminated and translated into major regional languages to minimize the complications. Diabetic patients who are stable, free of deteriorating complications and able to manage can be allowed to fast.
authors.affiliation: University Diabetes Center, King Saud University, College of Medicine, Riyadh, Saudi Arabia. sultanmeo@hotmail.com/smeo@ksu.edu.sa.
authors.forename: A
authors.initials: A
authors.lastname: Hassan
authors.forename: S A
authors.initials: SA
authors.lastname: Meo
authors.forename: A M
authors.initials: AM
authors.lastname: Usmani
authors.forename: T J
authors.initials: TJ
authors.lastname: Shaikh
mesh_terms: D003681:Dehydration / Q000517:prevention & control; D048909:Diabetes Complications / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000188:drug therapy; D005215:Fasting; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007514:Islam; D008962:Models, Theoretical; D010353:Patient Education as Topic; D012306:Risk; D013927:Thrombosis / Q000517:prevention & control
chemical_list: D007004:Hypoglycemic Agents