Prise en charge des patients diabétiques au cours du jeûne du Ramadan: application des recommandations internationales en pratique clinique

Fasting is not without risk in diabetic patients. The aim of our study was to assess the impact of fasting on glycémic control in diabetic patients prepared for fasting as recommended by the American Diabetes Association (ADA) in 2010. We conducted a prospective cohort study in 2014, including diabetic patients wishing to fast during Ramadan, consenting to take part in this study. Were excluded patients considered at very high risk according to ADA classification. Patients included had a consultation before the month of Ramadan (D0) consisting of education and treatment adjustment. This was followed by a medical visit during Ramadan (J7), then at J30 and J60. Results analysis was done using SPSS Smartviewer15.0 Our study included 34 patients, of whom 60% were women, with a mean age of 50.4 years, an average 6.2-year diabetes history, and a mean body mass index of 27.83kg/m(2). Therapeutic adjustments (D0) were: decrease dose of sulphonylurea (SH), gliptine add in patients at risk of hypoglycaemia, and a metformin dose distribution. During the first week (D7) two patients had a lower hypoglycemia 0.7g/l before breaking the fast and 38% of the sample showed hyperglycemia great than; 2g/l after breaking the fast. We noted dietary errors in 15% of patients. Adjusting at J7 was to modify the dose of SH or to add a gliptine. No patient showed major hyperglycemia, ketosis or severe hypoglycemia. One patient presented an atrial fibrillation on unknown ischemic cardiopathy with acease of fasting. Three patients gave up fasting between J15 and J20 due to an intense asthenia without hyperglycemia. Mean HbA1c in patients after the fasting was 7.10 versus 6.8% before fasting (p = 0.42). Factors significantly associated to poor glycemic control were mainly HbA1C rate at admission (p = 0.002), absence of self-monitoring (p = 0.01) and diabetes duration (p = 0.06). This study allowed us to show that a good evaluation of diabetic risk level, an education, a glycemia monitoring and an adjustment of the treatment by implementing international recommendations to allow fasting for Muslim diabetic patients with low risk of acute complications and metabolic disorders. A medical visit during the month of Ramadan (D7) would allow for correction of the dietetic mistakes and adjustment of oral agents if necessary.