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      Exploring Drug-Related Problems in Diabetic Patients during Ramadan Fasting in Saudi Arabia: A Mixed-Methods Study

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          Abstract

          This study aimed to identify any drug-related problems (DRPs) in diabetic patients during Ramadan fasting in Saudi Arabia. The study used a mixed-methods approach consisting of two phases and was conducted in Makkah, Saudi Arabia from December 2017 to March 2018. The first phase of the study involved qualitative semi-structured individual interviews with diabetic patients. A 13-item questionnaire was used in the second phase to further identify DRPs in the wider population. The data was mainly presented as frequencies and percentages. Inferential statistics was performed using Statistical Package for Social Sciences (SPSS) version 21 to compare relevant variables/questions using the chi-square test. Twenty patients (10 male, 10 female) attended face-to-face interviews during the first phase of the study while 95 (40 male, 55 female) completed the questionnaire in the second phase of the study. Two possible risk factors for DRPs were identified from the qualitative data: patient-related factors, including changes in their medicine intake during fasting, and healthcare professionals-related factors, including lack of advice from healthcare professionals regarding fasting. The quantitative results indicated that 52 (54%) of the 95 participants who observed fasting reported to have changed the way they were taking their medicines. Furthermore, 41% of the participants experienced general healthcare problems such as hypoglycemia, hyperglycemia, fatigue, excessive sweating, and gastrointestinal disturbances. Healthcare professionals need to educate patients who are at risk of DRPs by providing structured education and counseling.

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          Diabetes Mellitus in Saudi Arabia: A Review of the Recent Literature.

          The World Health Organization (WHO) has reported that Saudi Arabia ranks the second highest in the Middle East, and is seventh in the world for the rate of diabetes. It is estimated that around 7 million of the population are diabetic and almost around 3 million have pre-diabetes. Even more worrying perhaps, is the increasing pattern of diabetes noted in Saudi Arabia in the recent past. In fact, diabetes has approximately registered a ten-fold increase in the past three eras in Saudi Arabia. Diabetes mellitus (DM) has been found to be related to high mortality, morbidity and vascular complications, accompanied by poor general health and lower quality of life. In Saudi Arabia, DM is quickly reaching disturbing proportions and becoming a significant cause of medical complications and even death. However, when compared with the developed countries, the research work conducted, focusing particularly on the incidence, prevalence and socio-demographic properties of DM is woefully inadequate. The health burden due to DM in Saudi Arabia is predicted to rise to catastrophic levels, unless a wide-ranging epidemic control program is incorporated, with great emphasis laid on advocating a healthy diet, including exercise and active lifestyles, and weight control. To properly manage the DM in Saudi Arabia, a multidisciplinary approach is required. In this review we discuss all the aspects of DM in Saudi Arabia drawing from the published literature currently available.
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            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.

            The aim of this study was to assess the characteristics and care of patients with diabetes in countries with a sizable Muslim population and to study diabetes features during Ramadan and the effect of fasting. This was a population-based, retrospective, transversal survey conducted in 13 countries. A total of 12,914 patients with diabetes were recruited using a stratified sampling method, and 12,243 were considered for the analysis. Investigators recruited 1,070 (8.7%) patients with type 1 diabetes and 11,173 (91.3%) patients with type 2 diabetes. During Ramadan, 42.8% of patients with type 1 diabetes and 78.7% with type 2 diabetes fasted for at least 15 days. Less than 50% of the whole population changed their treatment dose (approximately one-fourth of patients treated with oral antidiabetic drugs [OADs] and one-third of patients using insulin). Severe hypoglycemic episodes were significantly more frequent during Ramadan compared with other months (type 1 diabetes, 0.14 vs. 0.03 episode/month, P = 0.0174; type 2 diabetes, 0.03 vs. 0.004 episode/month, P < 0.0001). Severe hypoglycemia was more frequent in subjects who changed their dose of OADs or insulin or modified their level of physical activity. The large proportion of both type 1 and type 2 diabetic subjects who fast during Ramadan represent a challenge to their physicians. There is a need to provide more intensive education before fasting, to disseminate guidelines, and to propose further studies assessing the impact of fasting on morbidity and mortality. Copyright 2004 American Diabetes Association
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              Ramadan Prospective Diabetes Study: the role of drug dosage and timing alteration, active glucose monitoring and patient education.

              To observe the effects of active glucose monitoring, alteration of drug dosage and timing, dietary counselling and patient education in the occurrence of acute diabetic complications in fasting individuals with diabetes during the month of Ramadan. This prospective study was conducted at the outpatient department of the Baqai Institute of Diabetology and Endocrinology. Two educational sessions, one about drug dosage and timing alteration and glucose monitoring, and the other about dietary and lifestyle modifications, were given to the patients by a doctor and a dietician, respectively. Patients who had been recruited were advised to note their blood glucose readings on a chart for at least 15 fasting days, twice a day with at least one reading in the fasting state. A total of 3946 readings were obtained in 110 subjects; 82 readings were in the hypoglycaemic range, and there were 22 episodes of symptomatic hypoglycaemia and 60 episodes of biochemical hypoglycaemia observed in 27 patients. Seven patients experienced symptomatic hypoglycaemia, whereas 20 patients had biochemical hypoglycaemia. Symptomatic hypoglycaemic episodes showed a downward trend from weeks 1 to 4. The highest frequencies of hypo- and hyperglycaemic episodes were observed pre-dawn. None of the patients developed diabetic ketoacidosis or hyperglycaemic hyperosmolar state. We observed that, with active glucose monitoring, alteration of drug dosage and timing, dietary counselling and patient education, the majority of the patients did not have any serious acute complications of diabetes during Ramadan. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                11 February 2019
                February 2019
                : 16
                : 3
                : 499
                Affiliations
                [1 ]College of Pharmacy, Umm al-Qura University, Taif Road, Makkah 24381, Saudi Arabia; waleed9055@ 123456hotmail.com (W.S.A.); momsmf@ 123456hotmail.com (M.M.A.); ph.waleed.ja@ 123456gmail.com (W.J.A.); abdulrhmanthaqafi@ 123456gmail.com (A.A.); hamed234@ 123456windowslive.com (H.A.A.); fahaddakilallh@ 123456gmail.com (F.A.); ph-jad@ 123456hotmail.com (A.A.A.); ph.amjaad@ 123456hotmail.com (A.A.M.); laaayaly-2009@ 123456windowslive.com (L.Y.B.); razxhr@ 123456gmail.com (R.I.A.); e_m_h_d@ 123456hotmail.com (E.M.D.); alhazmi.anwar.h@ 123456gmail.com (A.H.A.); majid.ali@ 123456hotmail.com (M.A.)
                [2 ]Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
                Author notes
                [* ]Correspondence: E.Cheema@ 123456bham.ac.uk
                Article
                ijerph-16-00499
                10.3390/ijerph16030499
                6388163
                30754675
                26ee66ed-6b67-44a5-b70b-b905961cfff4
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 24 December 2018
                : 05 February 2019
                Categories
                Article

                Public health
                medicines,diabetes,ramadan,fasting
                Public health
                medicines, diabetes, ramadan, fasting

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