Incidence of hypoglycemia among patients with type 2 diabetes who fasted during Ramadan

Background and Objectives: Fasting causes a major change in the dietary habits including the frequency, the timing, and the patterns which will result in a major change in the metabolic response of the body. Physicians should advise the patients about the complications of diabetes mellitus during fasting especially hypoglycemia, the aim of this study is to determine the relation between fasting Ramadan in type 2 diabetes and hypoglycemia risk. Methods: This is a cross-sectional prospective study, which included 304 Muslim patients with type 2 diabetes mellitus who are receiving oral hypoglycemic agents as management were included in this study, while those on insulin were excluded. These patients had decided to fast Ramadan during 2019 in two cities, 122 patients were from Duhok city and 183 patients from Erbil city, Kurdistan region of Iraq. All patients’ body mass index recorded and a blood sample was taken to measure HbA1c and lipid profile. Results: Most patients had no attacks of hypoglycemia (86.20%), while 13.80% had one or more hypoglycemic attacks. The attacks of hypoglycemia confirmed clinically and biochemically that is by checking random blood sugar. There was no significant correlation between the hypoglycemic attacks and the variables studied in this article, such as the duration of diabetes, oral hypoglycemic agents, however, there was significant relation between hypoglycemic attacks and days of fasting in Ramadan and ready to break fasting (P value of 0.026 and 0.008 respectively). Conclusion: There was no association between fasting Ramadan and development of hypoglycemic attacks, however physicians must warn patients about the possible risk of hypoglycemia during fasting and it’s the patient’s own decision to continue fasting or not.