ESPE Abstracts

Background: Many Muslim adolescents and children insist on fasting during the holy month of Ramadan. There are limited data on the patterns of diabetes management specifically about children and adolescents.

Aim: To ascertain the knowledge, attitude, and practices to the management of diabetes during Ramadan fasting among physicians who look after children and adolescents living with diabetes in Arab countries.

Methods: An electronic survey was distributed to a large pool of practicing physicians associated with the ASPED countries (no=464). The questionnaire covered several aspects of management of Ramadan fasting in young patients with diabetes. The survey was provided in English and French.

Results: Of the 166 eligible responders, 142 (85.5%) were pediatricians, and the remaining 20 (12.1%) were adult physicians; all but 10 were specialists or consultants. Most respondents (79.6%) would allow their patients to fast, Ramadan, if they asked for it and 75.2% of them favored structured educational sessions 2–4 weeks before Ramadan, but 23.5% would do it earlier up to 2–3 months. 34.8%, 37.5%, and 24.1% of respondents allow their patients to fast by the age of 14 and 12 and ten years respectively; while 3.6% allow fasting as young as eight years. 31.0% and 39.3% of the participants stated thought their patients can complete 50% and 80% of the fasting days. 46.9% stated that hypoglycemia unawareness was the most serious complication for a patient to be at ‘very high-risk’ from fasting. 62% of the respondents reported that fasting has to be broken if symptomatic hypoglycemia occurred regardless of the blood glucose level fast and 48.2% of them thought fasting should be discontinued if blood glucose exceeded 300 mg/dl (48.2%). 63.4% of respondents decreased the dose of basal insulin by 25% from original dose, but 23.2% would reduce it by 10% only. 56.4% used rapid-acting analog with meals according to carbohydrate counting. 81.1% recommend a specific dietary regimen for their patients. 52.8% thought that use of insulin pumps decreases the frequency hypoglycemia during fasting compared to multiple daily injections; however, 39.6% were not pump users.

Conclusions: There is a wide variation in the management of children and adolescents with diabetes during Ramadan among ASPED members. This observation calls for targeted educational efforts in the region, highlights the need for ASPED- sponsored guidelines to help clinicians meet the challenges in this area of diabetes care.