Pharmacologic management of diabetes during Ramadan

Fasting during the lunar month of Ramadan is regarded as an integral pillar of Islam. During this holy month, many Muslims around the world abstain from eating and drinking from sunrise to sundown. Depending on geography, these fasts can range from 12 to 20 hours. Fasting in itself causes many physiological changes within the body, but individuals with diabetes who observe the month of Ramadan are at risk of many additional physiologic complications, ranging from hypoglycaemia and ketoacidosis to thrombosis due to dehydration. Healthcare professionals not accustomed to or familiar with Ramadan lack knowledge regarding the pharmacologic modifications required for patients with diabetes during the fast. While some guidelines do exist, they are not widely known or followed, and such data is not published in any medication reference text such as the British National Formulary (BNF) or Lexicomp. Presented here are the current guidelines implemented by the International Diabetes Federation (IDF) and the Diabetes and Ramadan (DAR) International Alliance, compiled from a range of studies regarding fasting and its implications for individuals with diabetes.