Harpreet Singh Bajaj1, Tyceer Abouhassan2, Muhammad Rauf Ahsan3, Amel Arnaout4, Mohamed Hassanein5, Robyn L Houlden6, Tayyab Khan7, Hasnain Khandwala8, Subodh Verma9. 1. LMC Diabetes & Endocrinology, Brampton, Ontario, Canada; Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada; STOP Diabetes Foundation, Brampton, Ontario, Canada. Electronic address: harpreet.bajaj@lmc.ca. 2. Schulich School of Medicine and Dentistry, Windsor, Ontario, Canada; Erie-St. Clair LHIN 1 Diabetes Lead, Windsor, Ontario, Canada. 3. Division of Cardiac Surgery, St Michael's Hospital, Toronto, Ontario, Canada. 4. University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada; Division of Endocrinology and Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada. 5. Endocrinology, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates; Postgraduate Diabetes Education, Cardiff University, Cardiff, United Kingdom; Diabetes and Ramadan International Alliance. 6. Division of Endocrinology, Queen's University, Kingston, Ontario, Canada. 7. STOP Diabetes Foundation, Brampton, Ontario, Canada; LMC Diabetes & Endocrinology, Oakville, Ontario, Canada; Harvard T. H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, United States. 8. LMC Diabetes & Endocrinology, Etobicoke, Ontario, Canada. 9. Division of Cardiac Surgery, St Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada.
Abstract
OBJECTIVE: Fasting from dawn to dusk during Ramadan, including abstaining from water and food, is 1 of the pillars of Islam and is observed by the majority of Muslims. Most research concerning diabetes and fasting during Ramadan originates from Middle Eastern or South Asian countries; however, differences exist in hours of work and fasting, pharmacotherapy and blood glucose monitoring between these countries and Canada. METHODS: An expert forum of 7 Canadian experts and 1 international expert collaborated to develop Canadian guidelines using the same evidence-based principles, with the exception of an independent methods review used for the Diabetes Canada clinical practice guidelines. Diabetes Canada scientific leadership and Canadian health-care providers performed independent external reviews. Religious leaders endorsed the position statement and provided letters of support. An informed patient participated in the position-statement development. Each recommendation was approved with 100% consensus of the expert forum. RESULTS: Recommendations for risk stratification, education, pharmacotherapy and blood glucose monitoring for adults with type 1 and type 2 diabetes who intend to fast during Ramadan have been developed. CONCLUSIONS: This is the first Canadian position statement on the topic of Ramadan fasting and diabetes. It was developed by an expert faculty and endorsed by Diabetes Canada, and provides guidance about pharmacotherapy and glucose monitoring for health-care providers so that they can assist Canadian Muslims living with diabetes to observe fasting during Ramadan safely.
OBJECTIVE: Fasting from dawn to dusk during Ramadan, including abstaining from water and food, is 1 of the pillars of Islam and is observed by the majority of Muslims. Most research concerning diabetes and fasting during Ramadan originates from Middle Eastern or South Asian countries; however, differences exist in hours of work and fasting, pharmacotherapy and blood glucose monitoring between these countries and Canada. METHODS: An expert forum of 7 Canadian experts and 1 international expert collaborated to develop Canadian guidelines using the same evidence-based principles, with the exception of an independent methods review used for the Diabetes Canada clinical practice guidelines. Diabetes Canada scientific leadership and Canadian health-care providers performed independent external reviews. Religious leaders endorsed the position statement and provided letters of support. An informed patient participated in the position-statement development. Each recommendation was approved with 100% consensus of the expert forum. RESULTS: Recommendations for risk stratification, education, pharmacotherapy and blood glucose monitoring for adults with type 1 and type 2 diabetes who intend to fast during Ramadan have been developed. CONCLUSIONS: This is the first Canadian position statement on the topic of Ramadan fasting and diabetes. It was developed by an expert faculty and endorsed by Diabetes Canada, and provides guidance about pharmacotherapy and glucose monitoring for health-care providers so that they can assist Canadian Muslims living with diabetes to observe fasting during Ramadan safely.
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