title: Recommendations for management of diabetes during Ramadan: update 2015.
abstract: Since the first ADA working group report on the recommendations for management of diabetes during Ramadan in 2005 and our update in 2010, we received many inquiries asking for regular updates on information regarding education, nutritional habits and new oral and injectable agents that may be useful for the management of patients with diabetes during Ramadan. Patients can be stratified into their risk of hypoglycemia and/or complications prior to the start of the fasting period of Ramadan. Those at high risk of hypoglycemia and with multiple diabetic complications should be advised against prolonged fasting. Even in the lower hypoglycemia risk group, adverse effects may still occur. In order to minimize adverse side effects during fasting in patients with diabetes and improve or maintain glucose control, education and discussion of glucose monitoring and treatment regimens should occur several weeks prior to Ramadan. Agents such as metformin, thiazolidinediones and dipeptidyl peptidase-4 inhibitors appear to be safe and do not need dose adjustment. Most sulfonylureas may not be used safely during Ramadan except with extreme caution; besides, older agents, such as chlorpropamide or glyburide, should not be used. Reduction of the dosage of sulfonylurea is needed depending on the degree of control prior to fasting. Misconceptions and local habits should be addressed and dealt with in any educational intervention and therapeutic planning with patients with diabetes. In this regard, efforts are still needed for controlled prospective studies in the field of efficacy and safety of the different interventions during the Ramadan Fast.
authors.affiliation: EDC, Center for Diabetes Education , McDonough, Georgia , USA.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Ibrahim
authors.affiliation: Department of Internal Medicine , Mansura University , Mansura , Egypt.
authors.forename: Megahed
authors.initials: M
authors.lastname: Abu Al Magd
authors.affiliation: Islamic Hospital , Amman , Jordan.
authors.forename: Firas A
authors.initials: FA
authors.lastname: Annabi
authors.affiliation: Department of Internal Medicine, Unit of Diabetes & Metabolism , Alexandria Faculty of Medicine , Alexandria , Egypt.
authors.forename: Samir
authors.initials: S
authors.lastname: Assaad-Khalil
authors.affiliation: Dammam Medical Complex , Dammam , Saudi Arabia.
authors.forename: Ebtesam M
authors.initials: EM
authors.lastname: Ba-Essa
authors.affiliation: Eastern Mediterranean Office of the World Health Organization , Cairo , Egypt.
authors.forename: Ibtihal
authors.initials: I
authors.lastname: Fahdil
authors.affiliation: Florence Nightingale Istanbul Hospital , Istanbul , Turkey.
authors.forename: Sehnaz
authors.initials: S
authors.lastname: Karadeniz
authors.affiliation: Division of Endocrinology , University of IL , Chicago, Illinois , USA.
authors.forename: Terry
authors.initials: T
authors.lastname: Meriden
authors.affiliation: Islamic Hospital , Amman , Jordan.
authors.forename: Aly A
authors.initials: AA
authors.lastname: Misha'l
authors.affiliation: Department of Endocrinology and Metabolism , University Campus Bio Medico , Rome , Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pozzilli
authors.affiliation: Diabetic Association of Pakistan , Karachi , Pakistan.
authors.forename: Samad
authors.initials: S
authors.lastname: Shera
authors.affiliation: NYU Lutheran , Brooklyn, New York , USA.
authors.forename: Abraham
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Saudi Diabetes Group , King Abdul Aziz University , Jeddah , Saudi Arabia.
authors.forename: Suhad
authors.initials: S
authors.lastname: Bahijri
authors.affiliation: National Institute for Health and Welfare , Helsinki , Finland.
authors.forename: Jaakko
authors.initials: J
authors.lastname: Tuomilehto
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine , Istanbul University , Istanbul , Turkey.
authors.forename: Temel
authors.initials: T
authors.lastname: Yilmaz
authors.affiliation: Emory University School of Medicine , Atlanta, Georgia , USA.
authors.forename: Guillermo E
authors.initials: GE
authors.lastname: Umpierrez
keywords: A1C; Dietary Behavior; Education and Behavioral Interventions