Title:Insulin Management for Type 2 Diabetes During Ramadan: A Narrative
Review for Clinicians
Volume: 19
Issue: 3
Author(s): Alexander Kieu*Ashley Iles
Affiliation:
- Family Medicine, Kanad Hospital, Al Ain, United Arab Emirates
- Department of Family Medicine, United Arab Emirates
University College of Medicine and Health Sciences, Al Ain, UAE
Keywords:
Type 2 diabetes mellitus, Islam, insulin, hypoglycemia, hyperglycemia, cultural competency.
Abstract:
Objective: Muslims with insulin-dependent type 2 diabetes are at high risk for adverse
events while fasting during the month of Ramadan. However, advances in pharmacologic therapy
coupled with creative strategies of insulin administration can mitigate complications. This narrative
literature review investigates which insulin subtypes are likely to prevent hypoglycemic events and
reduce hyperglycemia during the Ramadan fasting season for this high-risk population.
Design: Narrative literature review
Eligibility Criteria: The following MeSH terms were used: “Diabetes Mellitus, Type 2” and “Insulin,”
and the “Text Words”: “Ramadan”, “iftar”, “Muslim fast”, and “religious fast.” The primary
focus was on adult, non-pregnant, insulin-dependent type 2 diabetes during Ramadan. Anything
beyond this focus was excluded. A total of nine pertinent studies were included for narrative review
and analysis.
Information Sources: PubMed, EMBASE and Medline.
Results: The studies identified suggest long-acting insulins reduce the risk of hypoglycemia, and
rapid-acting insulin analogues may improve post-iftar hyperglycemia. Moreover, utilizing flexible
glycemic targets during Ramadan is a novel strategy that has demonstrated improved outcomes after
the fasting season.
Conclusion: Certain insulin subtypes and dosing strategies may be advantageous to use during
Ramadan. However, a systematic, comprehensive, and updated review, including a critical appraisal
of each original study, is needed to improve clinical care of insulin-dependent type 2 diabetes
during Ramadan.
