title: The effect of Ramadan fasting on glycaemic control in insulin dependent diabetic patients: A literature review.
abstract: BACKGROUND
  Ramadan fasting is one of the five pillars of Islam. People with diabetes are exempted from fasting according to Islamic rules. However, many people with diabetes wish to fast. Physicians are asked frequently by their patients about their ability to fast and the possible impact of fasting on their glycaemic control. Studies about the effect of Ramadan on people with insulin-treated diabetes are scarce. This review aims to provide clinicians with the best recommendations for their patients with insulin-treated diabetes who wish to fast.
  
  
  METHODS
  Four databases (Medline, EMBASE, Scopus and PubMed) were searched using the following MeSH terms and keywords: "insulin dependent diabetes mellitus", "type 1 diabetes mellitus", 'Ramadan' "and" "fasting". In addition, a hand search of key journals and reference lists was performed. Sixteen full text articles were selected for review and critical analysis.
  
  
  RESULTS
  All of the included studies except one found improvement or no change in glycaemic control parameters during Ramadan fasting. The incidence of major complications were negligible. Minor hypoglycaemic events were reported in some studies but did not adversely affect fasting. Postprandial hyperglycaemia was a major concern in other studies. However, the incidence of severe hyperglycaemia and diabetic ketoacidosis were trivial.
  
  
  CONCLUSIONS
  Ramadan fasting is feasible for insulin dependent diabetic patient who wish to fast. Clinicians should advise their patients about the importance of adequate glycaemic control before Ramadan and frequent glucose monitoring during fasting. Certain types of Insulin seem to be more beneficial than other.
authors.affiliation: Faculty of Medicine and Health Sciences/Macquarie University; Basra Medical College, Basra, Iraq. Electronic address: dr_majid79@yahoo.com.
authors.forename: Majid H
authors.initials: MH
authors.lastname: Alabbood
authors.affiliation: Faculty of Medicine and Health Sciences/Macquarie University.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Ho
authors.affiliation: Faculty of Medicine and Health Sciences/Macquarie University.
authors.forename: Mary R
authors.initials: MR
authors.lastname: Simons
mesh_terms: D048909:Diabetes Complications / Q000517:prevention & control*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005215:Fasting / Q000009:adverse effects*; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000517:prevention & control*; D007003:Hypoglycemia / Q000209:etiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007514:Islam
chemical_list: D007004:Hypoglycemic Agents
keywords: Diabetes mellitus; Insulin dependent diabetes; Ramadan