title: Impact of an individualized type 2 diabetes education program on clinical outcomes during Ramadan.
abstract: OBJECTIVE
  To determine if individualized education before Ramadan results in a safer fast for people with type 2 diabetes.
  
  
  METHODS
  Patients with type 2 diabetes who received care from participating clinics in Egypt, Iran, Jordan and Saudi Arabia and intended to fast during Ramadan 2014 were prospectively studied. Twelve clinics participated. Individualized education addressed meal planning, physical activity, blood glucose monitoring and acute metabolic complications and when deemed necessary, provided an individualized diabetes treatment plan.
  
  
  RESULTS
  774 people met study criteria, 515 received individualized education and 259 received usual care. Those who received individualized education were more likely to modify their diabetes treatment plan during Ramadan (97% vs 88%, p<0.0001), to perform self-monitoring of blood glucose at least twice daily during Ramadan (70% vs 51%, p<0.0001), and to have improved knowledge about hypoglycemic signs and symptoms (p=0.0007). Those who received individualized education also reduced their body mass index (-1.1±2.4 kg/m(2) vs -0.2±1.7 kg/m(2), p<0.0001) and glycated haemoglobin (-0.7±1.1% vs -0.1±1.3%, p<0.0001) during Ramadan compared those who received usual care. There were more mild (77% vs 67%, p=0.0031) and moderate (38% vs 19%, p<0.0001) hypoglycemic events reported by participants who received individualized education than those who received usual care, but fewer reported severe hypoglycemic events during Ramadan (23% vs 34%, p=0.0017).
  
  
  CONCLUSIONS
  This individualized education and diabetes treatment program helped patients with type 2 diabetes lose weight, improve glycemic control and achieve a safer fast during Ramadan.
authors.affiliation: Department of Internal Medicine , University of Michigan , Ann Arbor, Michigan , USA.
authors.forename: Laura N
authors.initials: LN
authors.lastname: McEwen
authors.affiliation: EDC, Center for Diabetes Education , McDonough, GA , USA.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Ibrahim
authors.affiliation: School of Medicine, Suez Canal University , Ismailia , Egypt.
authors.forename: Nahed M
authors.initials: NM
authors.lastname: Ali
authors.affiliation: Alexandria Faculty of Medicine , Alexandria University , Alexandria , Egypt.
authors.forename: Samir H
authors.initials: SH
authors.lastname: Assaad-Khalil
authors.affiliation: Ain Shams University , Cairo , Egypt.
authors.forename: Hyam Refaat
authors.initials: HR
authors.lastname: Tantawi
authors.affiliation: School of Medicine, Suez Canal University , Ismailia , Egypt.
authors.forename: Gamela
authors.initials: G
authors.lastname: Nasr
authors.affiliation: Department of Pharmacology and Nutritional Sciences , University of Kentucky, Lexington, Kentucky , USA.
authors.forename: Shayan
authors.initials: S
authors.lastname: Mohammadmoradi
authors.affiliation: Isalmic Hospital , Amman , Jordan.
authors.forename: Aly A
authors.initials: AA
authors.lastname: Misha'l
authors.affiliation: Isalmic Hospital , Amman , Jordan.
authors.forename: Firas A
authors.initials: FA
authors.lastname: Annabi
authors.affiliation: Dammam Medical Complex , Dammam , Saudi Arabia.
authors.forename: Ebtesam M
authors.initials: EM
authors.lastname: Ba-Essa
authors.affiliation: Saudi Diabetes Research Group (SDRG) , King Fahd Medical Research Center, King Abdulaziz University , Jeddah , Saudi Arabia.
authors.forename: Suhad M
authors.initials: SM
authors.lastname: Bahijri
authors.affiliation: University of Helsinki , Helsinki , Finland.
authors.forename: Jaakko
authors.initials: J
authors.lastname: Tuomilehto
authors.affiliation: Wayne State University , Detroit, Michigan , USA.
authors.forename: Linda A
authors.initials: LA
authors.lastname: Jaber
authors.affiliation: Department of Internal Medicine , University of Michigan , Ann Arbor, Michigan , USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
keywords: Education; Fasting; Hypoglycemia; Self-Management