Impact of Ramadan-Focused Education Program on Hypoglycemia Risk and Metabolic Control for Patients with Type 2 Diabetes Mellitus: A Systematic Review

Background: Ramadan fasting is regarded as a form of worship among Muslims. However, patients with a high risk of diabetic complications are advised to avoid fasting, as the practice is associated with significant impacts on several health factors for type 2 diabetic patients, including glycemic control. Thus, a lack of adequate education before Ramadan may result in negative health outcomes.

Aim: To evaluate the impact of a Ramadan-focused education program on hypoglycemic risk and other clinical and metabolic parameters.

Methods: A systematic literature search was performed using Scopus and PubMed to identify relevant studies meeting the inclusion criteria from inception to November 2018. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and guidelines were followed when performing the search and identification of appropriate studies.

Results: Seventeen studies were included in this systemic review; six of them met the criteria to compile for a meta-analysis. The included studies were with various study designs, including randomized controlled trials, quasi-experimental and non-randomized studies. Overall, the results revealed a significant reduction of hypoglycemia risk (81% reduction) for fasting patients in intervention groups who received Ramadan-focused education compared with patients receiving conventional care (OR 0.19, 95% CI: 0.08-0.46). Moreover, HbA1c significantly improved among patients who received a Ramadan-focused education intervention, compared with those receiving conventional care.

Conclusion: Ramadan-focused education programs had a significant impact on hypoglycemia and glycemic control, with no significant effect on body weight, blood lipids or blood pressure.