Ülkü Demirci¹* and Ayşegül Kaptanoğlu²

¹Department of Nutrition and Dietetics, Faculty of Health Sciences, İstanbul Aydın University, Istanbul, Turkey
²Department of Health Management, Faculty of Health Sciences, İstanbul Aydın University, Istanbul, Turkey

*Corresponding Author: Ülkü Demirci, Department of Nutrition and Dietetics, Faculty of Health Sciences, İstanbul Aydın University, Istanbul, Turkey

Received: April 24, 2023; Published: May 16, 2023

Abstract

Background and aim: Despite the increased risk of diabetes and the associated complications, many Muslim patients suffering from type 2 diabetes mellitus (T2DM) prefer to observe Ramadan fasting. For the better understanding of the patients’ perspective regarding fasting and help physicians offer better patient-centric care, we evaluated the religious and Ramadan fasting beliefs and practices of diabetic Muslims through this study.

Methods: A set of 150 Muslim subjects with T2DM, voluntarily participated in this cross-sectional study. The subjects were given an ad-hoc questionnaire comprising of total 40 items, divided into two subscales to investigate: (a) Ramadan fasting beliefs and practices; (b) Religious beliefs and practices.

Results: The patients’ mean age was 52.08 ± 11.11 years. They fasted for 27.85 ± 2.31 days. The overall Cronbach’s alpha coefficient (α) had excellent reliability at 0.91. The multivariate analyses indicated that subsequently adjusting for confounders, employment status [beta standardized coefficient (β) = 0.060; T = 0.843; P = 0.000], age (β standardized coefficient = -0.142; T = -1.658; P = 0.001), educational level (β standardized coefficient = 0.045; T = 0.637; P = 0.002), fasting and religious beliefs and practices (β standardized coefficient = -0.199; T = -2.917; P = 0.004), and diabetes complications and comorbidities (β standardized coefficient = 0.194; T = -2.775; P = 0.006) significantly governed the total count of fasting days.

Conclusions: Both Ramadan and religious beliefs played a significantly influential role in the decision-making process of diabetics who decided to fast during Ramadan. However, more studies need to be done in this area.

Keywords:Humans; Islam; Diabetes Complications; Fasting; Surveys; Questionnaires

References

1. Kridli SA. “Health Beliefs and Practices of Muslim Women during Ramadan”. MCN: The American Journal of Maternal/Child Nursing 4 (2011): 216-221.
2. International Diabetes Federation and DAR International Alliance. Diabetes and Ramadan: Practical Guidelines, Brussels, Belgium: International Diabetes Federation (2021). 
3. Akgül S., et al. “Fasting during Ramadan: a religious factor as a possible trigger or exacerbator for eating disorders in adolescents”. International Journal of Eating Disorders 8 (2014): 905-910.
4. Husain S., et al. “Ramadan and public health: a bibliometric analysis of top cited articles from 2004 to 2019”. Journal of Infection and Public Health 2 (2020): 275-280.
5. Ahmed UZ and Lykke JA.“Ramadan, fasting and pregnancy”. Ugeskr Laeger 29 (2014): V03140144.
6. Badshah A., et al. “Management of diabetesin Ramadan”. Journal of Ayub Medical College Abbottabad 4 (2018): 596-602.
7. Youssef A. “Fasting in Islam, the rules of Sawm in Ramadan. Assabile 3 (2018): 8.
8. The Holy Quran. Surah Al-Baqarah (Chapter 2) verses (2011): 183-185.
9. Salti I., et al. “A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study”. Diabetes Care 10 (2008): 2306-2311.
10. Hassanein M., et al. “Ramadan fasting in people with type 1 diabetes during COVID-19 pandemic: the DaR Global survey”. Diabetes Research and Clinical Practice 172 (2021): 108626.
11. Al Awadi FF., et al. “Patterns of diabetes care among people with Type 1 diabetes during Ramadan: an international prospective study (DAR-MENA T1DM)”. Advances in Therapy 4 (2020): 1550-63.
12. Babineaux SM., et al. “Multi-country retrospective observational study of the management and outcomes of patients with Type 2 diabetes during Ramadan in 2010 (CREED)”. Diabetic Medicine 6 (2015): 819-828.
13. Hassanein M., et al. “The characteristics and pattern of care for the type 2 diabetes mellitus population in the MENA region during Ramadan: an international prospective study (DAR-MENA T2DM)”. Diabetes Research and Clinical Practice 151 (2019): 275-284.
14. Hassanein M., et al. “The DAR 2020 Global survey: Ramadan fasting during COVID 19 pandemic and the impact of older age on fasting among adults with Type 2 diabetes”. Diabetes Research and Clinical Practice 173 (2021): 108674.
15. Sun H., et al. “IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045”. Diabetes Research and Clinical Practice 183 (2022):
16. Spanakis EK and Golden SH. “Race/ethnic difference in diabetes and diabetic complications”. Current Diabetes Reports 6 (2013): 814-823.
17. Azizi F. “Islamic fasting and health”. Annals of Nutrition and Metabolism 4 (2010): 273-282.
18. Abdessadek M., et al. “Follow-up of glycemic index before and after Ramadan fasting in type 2 diabetes patients under antidiabetic medications”. Annales Pharmaceutiques Françaises 5 (2019): 374-381.
19. Moghadam MT., et al. “Ramadan fasting during the COVID-19 pandemic; observance of health, nutrition and exercise criteria for improving the immune system”. Frontiers in Nutrition 7 (2021): 570235.
20. Kacimi S., et al. “Intermittent fasting during Ramadan attenuates proinflammatory cytokines and immune cells in healthy subjects”. Nutrition Research 12 (2012): 947-955.
21. Javanmard SH and Otroj Z. “Ramadan fasting and risk of COVID-19”. International Journal of Preventive Medicine 11 (2020): 60.
22. Li X., et al. “Molecular immune pathogenesis and diagnosis of COVID-19”. J Pharm Anal 2 (2020): 102-108.
23. Mo'ez Al-Islam EF., et al. “Impact of diurnal intermittent fasting during Ramadan on inflammatory and oxidative stress markers in healthy people: systematic review and meta-analysis”. J Nutr Intermed Metab 15 (2015): 18-26.
24. Mushtaq R., et al. “The role of inflammatory markers following Ramadan Fasting”. Pakistan Journal of Medical Sciences 1 (2016): 77-81.
25. Adawi M., et al. “Ramadan fasting exerts immunomodulatory effects: insights from a systematic review”. Frontiers in Immunology 8 (2017): 1144.
26. Akrami Mohajeri F., et al. “Dose Ramadan fasting affects inflammatory responses: evidences for modulatory roles of this unique nutritional status via chemokine network”. Iranian Journal of Basic Medical Sciences 12 (2020): 1217-1222.
27. Jabbar A., et al. “CREED study: hypoglycaemia during Ramadan in individuals with Type 2 diabetes mellitus from three continents”. Diabetes Research and Clinical Practice 132 (2017): 19-26.
28. Hassanein MM., et al. “Changes in fasting patterns during Ramadan, and associated clinical outcomes in adults with type 2 diabetes: a narrative review of epidemiological studies over the last 20 years”. Diabetes Research and Clinical Practice 172 (2021): 108584.
29. Beshyah SA., et al. “Risk of diabetic ketoacidosis during Ramadan fasting: a critical reappraisal”. Diabetes Res Clin Pract 151 (2019): 290-298.
30. Amiel SA., et al. “Hypoglycaemia in type 2 diabetes”. Diabetic Medicine 3 (2018): 245-254.
31. Aslam M and Healy MA. “Compliance and drug therapy in fasting Moslem patients”. Journal of Clinical Pharmacy and Therapeutics 5 (1968): 321-325.
32. Barber SG., et al. “Muslims, Ramadan, and diabetes mellitus”. The BMJ 6181 (1971): 46-47.
33. Gaborit B., et al. “Ramadan fasting with diabetes: an interview study of inpatients’ and general practitioners’ attitudes in the South of France”. Diabetes and Metabolism5 (2011): 395-402.
34. Savaş E. “Attitudinal determinants of Turkish diabetic patients and physicians about Ramadan fasting”. Journal of Religion and Health 1 (2018): 47-56.
35. Bragazzi NL. “Ramadan fasting and chronic kidney disease: a systematic review”. Journal of Research in Medical Sciences 7 (2014): 665.
36. Hinkle DE., et al. “Applied statistics for the behavioral sciences”. Boston, MA: Houghton Mifflin Company (2003).
37. Ramadan: Fasting and Traditions. Archived from the original (2019). 
38. Felias-Christensen G and Corl “Muslim Religious Observances and Diabetes (2015).
39. Why Ramadan brings us together. Archived 30 August 2009 at the Wayback Machine; BBC (2008).
40. Help for the Heavy at Ramadan.Archived 20 October 2016 at the Wayback Machine, Washington Post (2008).
41. Ramzan festival 2020: Know about Baakhabar Saint on Ramadan. SA News Channel (2020).
42. Patel NR., et al. “Having diabetes and having to fast: a qualitative study of British Muslims with diabetes”. Health Expect 5 (2015): 1698-1708.
43. Lee SW., et al. “Strategies to make Ramadan fasting safer in type 2 diabetics: a systematic review and network meta-analysis of randomized controlled trials and observational studies”. Medicine (Baltimore)2 (2011): e2457.
44. Afandi B., et al. “Ramadan challenges: fasting against medical advice”. Journal of Fasting and Health3 (2017): 133-137.
45. Ahmadani MY., et al. “Glycaemic trend during Ramadan in fasting diabetic subjects: a study from Pakistan”. Pakistan Journal of Biological Sciences 16 (2008): 2044-2047.
46. Ba-Essa EM., et al. “Attitude and safety of patients with diabetes observing the Ramadan fast”. Diabetes Research and Clinical Practice 152 (2019): 177-182.
47. Al-Balhan E., et al. “To fast or not to fast during the month of Ramadan? A comprehensive survey on religious beliefs and practices among Moroccan diabetic patients”. Diabetes, Metabolic Syndrome and Obesity 11 (2018): 633.
48. Khazaei HA. “The effect of fasting on the immune system of athletes during holly Ramadan”. Zahedan Journal of Research in Medical Sciences 6 (2014): 44-46.
49. Elmehdawi RR., et al. “Fasting of Ramadan in peoples with diabetes in Benghazi, Libya: an exploratory study”. Libyan Journal of Medicine 5.1 (2010): 5036.
50. Hilal“Ramadan and diabetes: should the diabetic be fasting?” Assabile 3 (2020): 8.
51. Hassanein M., et al. “Diabetes and Ramadan: practical guidelines”. Diabetes Research and Clinical Practice 126 (2017): 303-316.
52. Zainudin SB., et al. “Diabetes education and medication adjustment in Ramadan (DEAR) program prepares for self-management during fasting with tele-health support from pre-Ramadan to post-Ramadan”. Therapeutic Advances in Endocrinology and Metabolism 8 (2018): 231-240.
53. Ali S., et al. “Guidelines for managing diabetes in Ramadan”. Diabetic Medicine 10 (2016): 1315-1329.
54. Zaina A., et al. “Diabetes and Ramadan fasting-update 2019”. Harefuah 5 (2019): 276-281.
55. Beshyah WS and Beshyah SA. “Bibliometric analysis of the literature on Ramadan fasting and diabetes in the past three decades (1989-2018)”. Diabetes Research and Clinical Practice 151 (2019): 313-322.
56. Eckersley RM. “Culture, spirituality, religion and health: looking at the big picture”. Medical Journal of Australia S10 (2007): S54-56.
57. Raveendran AV and Zargar AH. “Diabetes control during Ramadan fasting”. Cleveland Clinic Journal of Medicine 5 (2017): 352-356.
58. Koenig HG. “Religion, spirituality, and medicine: research findings and implications for clinical practice”. Southern Medical Journal 12 (2004): 1194-1200.

Citation

Citation: Ülkü Demirci and Ayşegül Kaptanoğlu. “Ramadan Fasting and Religious Beliefs and Practices amongst the Muslim Diabetic Patients during COVID-19 Pandemic". Acta Scientific Nutritional Health 7.6 (2023): 44-51.

Copyright

Copyright: © 2023 Ülkü Demirci and Ayşegül Kaptanoğlu. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.