MON-654 Attitudes and Practice of Fasting Ramadan in Patients with Diabetes
Authors: Al-Qarni Ali , Alamoudi Reem Mohammad , Al-Aidarous Salwa , Alshahrani Awad , Abuhelalah Munir , Ahmed Gasmelseed 
Published: May 2020

Abstract
Background: Fasting Ramadan is practiced by Muslims globally. Compliance with health team advice on ability to fast or not, medication and lifestyle adjustments are the corner stone of achieving optimal diabetes control and avoiding complications with fasting. We aimed in this study to evaluate the attitudes and practice of Muslim patients with diabetes during fasting Ramadan, and to assess their compliance with the medical instructions provided by their healthcare team.
Methods: A cross-sectional study conducted in four Medical Centers under the Ministry of National Guard health affairs in four cities: Al-Ahsa, Dammam, Jeddah and Riyadh. All patients with diabetes followed in the diabetes clinics within three months post Ramadan and who met the study inclusion and exclusion criteria were approached and consented for participation in the study, and then filled a self-administered validated 15 items questionnaire.
Results: Data for 1438 diabetics were analyzed; 1207 (83.9%) T2DM and 231 (16.1%) T1DM. The mean age was 57.9 ± 14.9 years. 270 (18.8%) suffered multiple comorbidities. 559 (46.3%) of T2DM vs 22 (9.5%) of T1DM were not familiar with the type of their diabetes. 883 (73.2%) of T2DM were on combination therapy. There was a significant difference between T1DM and T2DM in health education received from the treating physician 168 (72.7%) vs 574 (47.6%) and from a dietician 165 (71.4%) vs 613 (50.8%) (p&lt;0.0001), but education received from diabetes educators was not significantly different 189 (81.8%) vs 936 (77.6%) (p=0.15). Patients who followed diet advise were only 55 (23.8%) vs 43 (36.4%), respectively, (p=0.0002). 1191 (82.8%) reported fasting the full month, 162 (11.3%) were advised by their physicians to not fast. Patients who did not fast full Ramadan were 247 (17.2%), one third 92 (37.25%) of them based on physician advise with a compliance rate of (56.8%). Blood sugar was not well controlled before Ramadan and did not change significantly after Ramadan with a mean HbA1c (8.41 ± 2.0 and 8.40 ± 2.1) respectively, p-value 0.53. Multivariate analyses revealed that being on insulin, and prior hospitalization for diabetes were significant predictors of compliance with physicians advice related to fasting Ramadan [(OR 4.5, 95% CI, 1.7 - 12.2, p-value 0.003), (2.3, 95% CI, 1.2 - 5.1, p-value 0.048)] respectively, while lack of receiving education, type of diabetes, and degree of glycemic control did not predict compliance with statistical significance [(OR 1.9, 95% CI, 0.8 - 4.6, p-value 1.5), (1.06, 95% CI, 0.4 - 2.6, p-value 0.89), (1.3, 95% CI, 0.5 - 3.5, p-value 0.56)] respectively. Majority of patients were aware of a religious “Fatwa” on fasting with diabetes but their understanding of it varied.
Conclusion: The study shows low level of patient awareness and compliance to health providers advice. Results indicate prior hospitalization and being on insulin treatment as predictors of patient compliance. This signifies the need for better structured diabetes and fasting education programs. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.