Incidence of diabetic ketoacidosis during Ramadan compared with non-fasting months in King Saud Medical City, Riyadh, Saudi Arabia

BACKGROUND: Ramadan in Islam is the ninth month of the Muslim calendar and the holy month of fasting. In the fasting state, there is the danger of the blood glucose levels becoming too high when normal levels of medication are not taken. This can lead to diabetic ketoacidosis (DKA). The risk of diabetic emergencies, including DKA, is thought to be higher during Ramadan fasting due to metabolic changes and alterations in food habits. We aim to assess the incidence of DKA during Ramadan and perform a comparison pre and post month of Ramadan. METHODS: This is a retrospective study that involves all adults who were admitted with DKA to King Saud Medical City in Riyadh, Saudi Arabia. We explored the relationship of admissions to Ramadan and compared it to the month before (Sha’aban) and the month after (Shawwal). RESULTS: During the duration of the study, 51 patients with DKA were admitted to the hospital. Nineteen patients in Ramadan (37.3%), eight patients in Sha’aban (15.7%), and 24 patients in Shawwal (47%). This shows a significant increment in Ramadan compared to Sha’aban, and more increment in Shawwal (P = 0.019). The most common precipitating factor for diabetic ketoacidosis during Ramadan and Sha’aban is missing insulin dose, while infections are considered the main stimulating agent in Shawwal. CONCLUSION: There was an increase in the incidence of DKA episodes in Ramadan compared with the preceding month, but fewer DKA events compared to Shawwal, which might indicate that Ramadan fasting is a potential risk factor for DKA.