Ramadan fasting among adults with type 2 diabetes in five geographically different regions of the world: The DAR 2020 global survey

Aims: The DAR 2020 survey summarised fasting practices and complications in people with type 2 diabetes (T2D) who fasted during Ramadan, and impact of pre-Ramadan diabetes education towards controlling the complications. Methods: Eight week post-Ramadan, Muslim people with T2D from 13 countries of five regions (South Asia, Southeast Asia, Gulf Nations, Middle East and North Africa) consented to answer questionnaire on breaking fast, hypoglycaemia, hyperglycaemia, Ramadan-focused diabetes education and self-monitoring of blood glucose (SMBG). Results: Among 4889 participants who observed Ramadan fast (>25 days), 51.1 % were females. Hypoglycaemia and hyperglycaemia was recorded mostly in North Africa (25.2 %) and Gulf Nations (30.2 %), respectively. In Middle East, 2.5 % and 3.1 % people required hospitalisation following hypoglycaemia and hyperglycaemia respectively. In South Asia, lowest incidents of hypoglycaemia (8.4 %) and hyperglycaemia (7.0 %) were noted. Pre-Ramadan diabetic education was received by total 45.9 % participants. SMBG was performed more frequently in North Africa (19.5 %). Metformin, Sulfonylureas and basal insulin were used most commonly in all regions. Conclusions: Fasting complications occurred in each region, but well-managed by the participants, physicians and family members amidst difficult time of COVID-19. The findings promote the necessity of patient education programmes for more people with diabetes to ensure safe fasting during Ramadan.