The effect of COVID-19 on Ramadan fasting in people with diabetes in East London 2020: The East London diabetes in Ramadan survey

AIMS: Fasting during the COVID-19 crisis was challenging for Muslim people with diabetes during Ramadan. We aimed to survey the experiences of patients with Type 2 diabetes (T2D) during Ramadan 2020. METHODS: Telephone survey of Muslim patients with T2D in Tower Hamlets, London. Patients were surveyed on the effects of COVID-19 on their fast, discussions with a healthcare professional (HCP) before Ramadan, whether they followed advice, number of fasts undertaken, medication changes and adverse events. RESULTS: 829 participated. 334 (40.2%) discussed fasting with a HCP; 198 (59.3%) were advised not to fast; 171 (86.3%) elected not to fast. 12 (1.4%) were admitted to hospital during Ramadan – one fasting related severe hypoglycaemia, one non-fasting cerebrovascular accident, and 10 (four fasting and six non-fasting) with COVID-19 symptoms. 34 (8.2%) patients in the fasting group developed COVID-19 symptoms before or during Ramadan; 30 (7.2%) in the non-fasting cohort. 311 (37.5%) patients said COVID-19 had significantly influenced their decision not to fast. Compared to Ramadan 2016, in Ramadan 2020 fewer people fasted (50.1% vs 55.4%), fewer people discussed fasting with a HCP (40.2% vs 52%), more patients who discussed fasting with their HCP were advised not to fast (59.3% vs 33.8%), and fewer patients fasted against medical advice (13.7% vs. 19.3%). CONCLUSIONS: COVID-19 had an impact on people with diabetes and their fasting intentions during Ramadan 2020. Most people who were advised not to fast did not fast; there were few adverse outcomes from fasting. COVID-19 was not more common amongst people who fasted.