Impact of an individualized type 2 diabetes education program on clinical outcomes during Ramadan

Objective: To determine if individualized education before Ramadan results in a safer fast for people with type 2 diabetes. Methods: Patients with type 2 diabetes who received care from participating clinics in Egypt, Iran, Jordan and Saudi Arabia and intended to fast during Ramadan 2014 were prospectively studied. Twelve clinics participated. Individualized education addressed meal planning, physical activity, blood glucose monitoring and acute metabolic complications and when deemed necessary, provided an individualized diabetes treatment plan. Results: 774 people met study criteria, 515 received individualized education and 259 received usual care. Those who received individualized education were more likely to modify their diabetes treatment plan during Ramadan (97% vs 88%, p< 0.0001), to perform self- monitoring of blood glucose at least twice daily during Ramadan (70% vs 51%, p< 0.0001), and to have improved knowledge about hypoglycemic signs and symptoms (p= 0.0007). Those who received individualized education also reduced their body mass index (-1.1 +/- 2.4 kg/m(2) vs - 0.2 +/- 1.7 kg/m(2), p< 0.0001) and glycated haemoglobin (- 0.7 +/- 1.1% vs - 0.1 +/- 1.3%, p< 0.0001) during Ramadan compared those who received usual care. There were more mild (77% vs 67%, p= 0.0031) and moderate (38% vs 19%, p< 0.0001) hypoglycemic events reported by participants who received individualized education than those who received usual care, but fewer reported severe hypoglycemic events during Ramadan ( 23% vs 34%, p= 0.0017). Conclusions: This individualized education and diabetes treatment program helped patients with type 2 diabetes lose weight, improve glycemic control and achieve a safer fast during Ramadan.