Ramadan diurnal intermittent fasting in patients with diabetes: assessment of knowledge, practices, risk of complications, and impact of pre-ramadan education.

Objectives: Evaluate diabetic patients' knowledge, practices, and the prevalence of complications during Ramadan fasting (RF) before and after an education program.

Methods: We conducted a prospective study including 140 consecutive diabetic patients (DP) who intended to observe RF in 2023. Patients underwent a questionnaire and received pre-Ramadan education (PRE) according to the IDF-DAR 2021 recommendations. Practices and outcomes (hypoglycemia, hyperglycemia, and cardiovascular events) of RF patients were determined during Ramadan 2022 and 2023 using a questionnaire.

Results: Participants mean age was 56.0 ± 9.3 years. Their knowledge level was good, average, and poor in 37.1%, 35%, and 27.9% of cases, respectively. Before RF 2022, 40.9% of patients reported consulting their physicians about diabetes management during fasting and 12.1% received education. The risk stratification showed that 45.7% of patients were at low risk, 32.9% at moderate risk, and 21.4% at high risk. Compared to 2022 RF, significant changes in eating patterns and physical activity practice were observed in 2023. Self-monitoring blood glucose (SMBG) was practiced by 35.6% of patients in 2022 and 75% in 2023 ( < 0.001). The number of patients who fasted the whole month of Ramadan and hypoglycemia prevalence were comparable between 2022 and 2023. Hyperglycemia prevalence was higher in 2023 (14.9%) than in 2022 (3%) ( < 0.001). No severe hypoglycemia, cardiovascular events, or hospital admissions were observed during RF 2022 and 2023.

Conclusion: The majority of diabetic patients had poor to average knowledge about diabetes and fasting. They were categorized as moderate- to high-risk of complications during RF. PRE had a positive impact on lifestyle, dietary patterns, and SMBG practice. Although this education did not lead to a decrease in hypoglycemia or hyperglycemia events, no severe metabolic or cardiovascular complications were reported.