Pre-Ramadan education helps reduce hypoglycaemic events in older diabetic patients

Educating older adult patients with diabetes prior to Ramadan fasting appears to have a favourable effect on the risk of developing symptomatic hypoglycaemia, according to a study.

The study included 316 type 2 diabetes patients (mean age 55.97 years, 70.3 percent female) who intended to fast, of whom 200 were aged <65 years (younger group) and 116 were aged ≥65 years (older group). Patients in both age groups participated in a focused pre-Ramadan education program.

The program involved individual sessions with a focus on advising patients about dietary habits, encouraging them to continue their daily physical activities, confirming the benefit of frequent blood sugar measurement during the fasting day, and adjusting their medication according to the recommendation.

At baseline, most patients in the older group were at moderate or high risk (43.10 percent and 37.9 percent, respectively). The mean HbA1c value was 9.69 in the younger group vs 8.95 in the older group (p=0.02).

Fasting blood glucose significantly decreased during and after Ramadan in the older group (p=0.0001). In this group, patients who achieved fasting blood glucose <8 mmol/L increased from 29.3 percent at baseline to 46.6 percent after Ramadan in older adult patients. HbA1c decreased significantly after Ramadan (p=0.001).

In both age groups, hypoglycaemia was the main reason for breaking fast (9 percent in the younger group vs 7.7 percent in the older group).

The older group saw a significant reduction in waist circumference (p=0.05) and numerical increases in total cholesterol (p=0.512) and low-density lipoprotein cholesterol (p=0.470). Meanwhile, high-density lipoprotein cholesterol levels improved in both groups during and after Ramadan (p=0.0001).

The findings suggest that older adults can achieve safe fasting with dietary modifications, drug dose adjustment, and regular glucose self-monitoring. Frequent blood measurement during fasting hours, especially midday hours, helps detect asymptomatic hypoglycaemia.