BACKGROUND: Ramadan is considered to be the holiest month of the Islamic religion. Hundreds of millions of Muslims practice the commitments of Ramadan, which include the abstinence from eating and drinking during daylight hours. Although there are exemptions to fasting for medical reasons, there is very limited guidance in terms of the safety of fasting in the postoperative period after bariatric surgery.
OBJECTIVE: To assess outcomes and impact of fasting on patients who underwent bariatric surgery within the year leading up to Ramadan 2023.
METHODS: Community hospital health system.
METHODS: Retrospective review of medical records and direct patient contact for 376 study participants.
RESULTS: Of the 376 participants who underwent bariatric surgery in the year before Ramadan, only 8 patients (2.1%) reported they did not intend to fast during Ramadan. Patients who ended up having to break fasting were closer to their surgery date, at 4.3 months from surgery, than patients who were able to fast for the entire month of Ramadan, who were 5.1 months out from surgery. There was no difference between the number of patients needing to break fasting on the basis of what type of bariatric surgery they had performed. The number of patients needing to go to the emergency department and receive intravenous fluids was small, at 11 patients (2.9%), and these patients were also closer to surgery than those not needing to go to the emergency department or receive intravenous fluids. Side effects experienced during Ramadan, including abdominal pain, nausea/vomiting, and hypoglycemia, were more common in patients that were closer to their surgery, notably within 4 months of their surgery date. Patients who lost weight during Ramadan were closer to their surgery date at 4.9 months from surgery compared with those who maintained or gained weight, who were 7.0 months out from surgery.
CONCLUSIONS: There are a limited number of studies examining the safety and patient outcomes in those who fast for religious purposes after bariatric surgery. In this study, 376 participants who were within 1 year of undergoing surgery were followed throughout the month of Ramadan. Patients closer to surgery were more likely to break fasting, present to the emergency department, and experience side effects. However, the overall rate of complications was low, suggesting that fasting in the setting of a religious tradition in the carefully chosen patient with counseling and supervision may be a safe option.

This study aims to determine the experiences of Muslim people with Type 2 Diabetes Mellitus (DM) about Ramadan in Türkiye. This phenomenological study was conducted with 30 Muslim people with Type 2 DM. The data were collected by holding in-depth individual interviews with a semi-structured interview form and analyzed using Colaizzi\'s seven-stage analysis and the MAXQDA-20 program. As a result, three main themes with 12 categories were determined as follows: (i) \"the month of Ramadan and the meaning of fasting\", (ii) \"the effects of fasting\", and (iii) \"coping with difficulties\". The participants stated that the month of Ramadan is one of the pillars of Islam and that it includes worshiping, finding peace, completing oneself in the religious sense, purifying oneself from sins, resting physically and spiritually, and appreciating the meaning of hunger, thirst, and blessings. However, some people reported that there was social pressure when they did not fast. Health professionals should provide people with DM with regular and safe training specific to Ramadan, establish support groups, and cooperate with religious officials (imams) to meet their religious demands.

UNASSIGNED: Managing diabetes during Ramadan fasting is a challenge due lifestyle changes. We described the characteristics and patterns of care for type 2 diabetes mellitus (T2DM) during Ramadan 2020 and 2022.
UNASSIGNED: Our study included multinational Muslims with T2DM who were during routine consultation. We collected data on demographics, fasting characteristics, and complications. Descriptive statistics, chi-square test, and multiple testing were performed.
UNASSIGNED: 12,529 patients participated. Mean age was 55.2 ± 11.8 years; 52.4% were females. Mean diabetes duration was 9.9 ± 7.4 years; 27.7% were with HbA1c >9% (75 mmol/mol) and 70% had complications. Metformin was the most used medication followed by insulin. 85.1% fasted ≥1 day; fasting mean duration was 27.6 ± 5.6 days. Hypoglycemia occurred in 15.5% of whom 11.7% attended emergency department or were hospitalized; this was significantly associated with age and/or duration of diabetes. Hyperglycemia occurred in 14.9% of whom 6.1% attended emergency department or were hospitalized and was also associated with age or duration of diabetes. 74.2% performed SMBG during fasting. 59.2% were educated on Ramadan fasting, with 89.7% receiving it during routine consultation.
UNASSIGNED: Ramadan fasting in T2DM is high. Multidisciplinary approach is required to mitigate complications. Our findings support current recommendations for safe fasting.
The goal of this survey was to describe the characteristics and current ways of care for Muslim patients with type 2 diabetes mellitus fasting during and after Ramadan 2020 and 2022. Most of the participants fasted a minimum of one day during Ramadan (85.1%). Overall, 15.5 and 14.9% reported low blood sugar levels or high blood sugar levels during fasting, respectively. Low blood sugar level was more reported in patients with older age, patients with longer diabetes duration, and women. High blood sugar level was more reported in patients with longer diabetes duration. Educational programs focusing on the risks occurring with fasting and practices that improve control of the disease will raise knowledge and awareness among patients with diabetes. Improving blood sugar control during Ramadan fasting remains a major need for both patients and healthcare providers who should collaborate to reduce the risk of diabetes-related problems.

OBJECTIVE: The impact of Ramadan fasting on the prevalence of renal colic (RC) remains controversial. This current study aimed to assess the correlation between Ramadan fasting, prevalence of RC and the rate of urgent endoscopic interventions due to urolithiasis.
METHODS: This retrospective case-control study enrolled adult patients with a primary diagnosis of RC secondary to urolithiasis admitted to the emergency department during the years 2009-2019. The prevalence of RC and the rate of urgent urological interventions during Ramadan were compared with the pre- and post-Ramadan months in fasting Muslims and non-fasting non-Muslim patients.
RESULTS: A total of 2781 patients with RC were included: 1014 (36.5%) were fasting Muslim and 1767 (63.5%) were non-fasting non-Muslim patients. No significant increase in RC admissions or urgent double J stent (DJS) insertions were observed between pre-Ramadan and Ramadan among fasting Muslims and non-fasting non-Muslim patients. However, fasting Muslims exhibited a significant increase of RC admissions post-Ramadan compared with Ramadan.
CONCLUSIONS: There was no correlation between increased RC admissions or urgent DJS insertions when fasting Muslims were compared with non-fasting non-Muslim patients during Ramadan. There were increased RC admissions during the post-Ramadan month, which might indicate a delayed effect of fasting on RC.

Ramadan is the Islamic holy month when Muslims around the world fast from dawn to sunset. This 30-day pattern of intermittent diurnal fasting can have a significant physiologic impact on the body. Importantly, oral intake is forbidden during this time, and many patients do not wish to take medications. From a clinical perspective, this potentially impacts healthcare delivery and chronic disease states. Despite these important changes, awareness of individual patient practices remains limited among healthcare providers in North America, which may worsen health disparities in Muslim patients. A fundamental understanding of the cultural and physiological implications of fasting during Ramadan can improve cultural competence and patient outcomes. In this paper, we review the physiologic changes during fasting, medical exemptions to fasting, and special considerations for the care of Muslim patients with chronic conditions who may fast during Ramadan.

UNASSIGNED: SGLT2 inhibitors are known for their osmotic diuretic effect, and their use by Muslim patients with type 2 diabetes during the fasting month of Ramadan may pose an increased risk of volume depletion, potentially impacting renal function.
UNASSIGNED: We conducted a systematic review registered on PROSPERO (registration number CRD42020204582) of studies published between 2013 and January 2023, sourced from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. The study selection criteria included controlled studies that reported the use of SGLT2 inhibitors (SGLT2i) by fasting adult type 2 diabetes patients and provided data on creatinine or estimated glomerular filtration rate (eGFR) as outcomes.
UNASSIGNED: Two prospective observational studies, encompassing a total of 359 participants, of which 197 utilized SGLT2 inhibitors, were identified. Our findings indicated that the use of SGLT2 inhibitors during Ramadan did not result in a significant alteration in eGFR. In one study by Hassanein et al., the mean changes in eGFR for the SGLT2i group, as compared to the non-SGLT2i group, were -1.2 ± 19.4 and 3.1 ± 14.8, respectively (p = 0.06). In a study by Shao et al., the least squares mean changes for eGFR in the SGLT2i group, compared to the non-SGLT2i group, were -6.0 ± 1.5 (95% CI, -8.9 to -3.1) and -4.2 ± 1.6 (95% CI, -7.3 to -1.1), respectively (p = 0.39).
UNASSIGNED: Despite the limited number of observational studies available, our analysis suggests that the use of SGLT2 inhibitors by type 2 diabetes patients during Ramadan does not appear to significantly impact kidney function.

OBJECTIVE: Ramadan, a significant month for Muslims, presents unique challenges, particularly in the context of the USA. This study aimed to explore the relationship between mental health factors (depression, anxiety, and stress), sleep quality, and psychological well-being (subjective happiness and life satisfaction) during the month of Ramadan among participants and by gender.
METHODS: This study enlisted 163 participants (74% female, 25.7% male), with an average age of 36.8 years (SD = 13.1), mostly of Middle Eastern descent. Recruitment was conducted via flyers at local community mosques, social media, and outreach through local religious leaders. Data collection took place in the last three weeks of Ramadan, utilizing a Qualtrics survey that included the Depression Anxiety and Stress Scale (DASS-21), the Subjective Happiness Scale (SHS), Satisfaction with Life Scale (SWLS), and the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed by means of descriptive statistics and multiple linear regression models using SPSS version 28.
RESULTS: The study indicates that while mental health and psychological well-being remained within normal levels during Ramadan, sleep scores indicated significant sleep disturbance among participants. Multiple linear regression models revealed that subjective happiness, sleep duration, and the global PSQI score were significant predictors of stress for the total sample (F = 9.816, p = 0.001). Life satisfaction was the only significant predictor of anxiety (F = 7.258, p = 0.001), and it, alongside subjective happiness, significantly predicted depression (F = 12.317, p = 0.001). For men, subjective happiness alone predicted stress, while life satisfaction was a predictor for both anxiety and depression (F = 4.637, p = 0.001). In women, sleep duration and medication usage were linked to stress but not anxiety. Life satisfaction and subjective happiness were, however, predictors of depression (F = 6.380, p = 0.001).
CONCLUSIONS: Fostering positive affective states can serve as a protective mechanism against the potential psychological distress associated with altered sleep patterns and lifestyle changes that accompany Ramadan. This study highlights that Ramadan is a tool for bolstering happiness and life satisfaction, thereby lowering levels of stress, anxiety, and depression. In non-Muslim majority contexts like the USA, there is a need for accommodations to safeguard against potential psychological distress.

OBJECTIVE: The objectives of this study were to evaluate the stratification of people with diabetes mellitus (DM) based on the International Diabetes Federation-Diabetes and Ramadan 2021 risk calculator into different risk categories and assess their intentions to fast and outcomes of fasting during the holy month of Ramadan.
METHODS: This was a 3-month prospective study that was performed from February 9, 2023, to May 6, 2023 (6 weeks before Ramadan until 6 weeks after Ramadan), at a tertiary care hospital in Pakistan. Data regarding glycemic control, characteristics and complications of diabetes, comorbidities, and the various factors that influence fasting were gathered from patients of either sex aged 18 to 80 years with any type of diabetes. The International Diabetes Federation-Diabetes and Ramadan 2021 risk calculation and recommendation were made accordingly for each patient.
RESULTS: This study comprised of 460 participants with DM, with 174 males (37.8%) and 286 females (62.2%). The risk categorization showed that 209 (45.4%), 107 (23.3%), and 144 (31.3%) of the participants were in the low-, moderate-, and high-risk categories, respectively. Of the 144 high-risk patients who fasted, 57.9% experienced hypoglycemia (P <.0001). The recommendation of fasting showed statistically significant differences with risk categories, intention to fast, hypoglycemia, type of DM, duration of DM, level of glycemic control, and days of fasting (P <.001).
CONCLUSIONS: A statistically significant number of participants in the high-risk group who fasted experienced complications. This reiterates the importance of rigorous adherence to the medical recommendations.

Prevalence of diabetes in Arab region has significantly increased, resulting in a significant economic burden on healthcare systems. This surge can be attributed to obesity, rapid urbanization, changing dietary habits, and sedentary lifestyles. The Arab Diabetes Forum (ADF) has established localized recommendations to tackle the region\'s rising diabetes prevalence. The recommendations, which incorporate worldwide best practices, seek to enhance the quality of treatment for people with diabetes by raising knowledge and adherence among healthcare providers. The guidelines include comprehensive recommendations for screening, diagnosing, and treating type 1 and type 2 diabetes in children and adults for better overall health results.

UNASSIGNED: SGLT2 inhibitors are known for their osmotic diuretic effect, and their use by Muslim patients with type 2 diabetes during the fasting month of Ramadan may pose an increased risk of volume depletion, potentially impacting renal function.
UNASSIGNED: We conducted a systematic review registered on PROSPERO (registration number CRD42020204582) of studies published between 2013 and January 2023, sourced from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. The study selection criteria included controlled studies that reported the use of SGLT2 inhibitors (SGLT2i) by fasting adult type 2 diabetes patients and provided data on creatinine or estimated glomerular filtration rate (eGFR) as outcomes.
UNASSIGNED: Two prospective observational studies, encompassing a total of 359 participants, of which 197 utilized SGLT2 inhibitors, were identified. Our findings indicated that the use of SGLT2 inhibitors during Ramadan did not result in a significant alteration in eGFR. In one study by Hassanein et al., the mean changes in eGFR for the SGLT2i group, as compared to the non-SGLT2i group, were -1.2 ± 19.4 and 3.1 ± 14.8, respectively (p = 0.06). In a study by Shao et al., the least squares mean changes for eGFR in the SGLT2i group, compared to the non-SGLT2i group, were -6.0 ± 1.5 (95% CI, -8.9 to -3.1) and -4.2 ± 1.6 (95% CI, -7.3 to -1.1), respectively (p = 0.39).
UNASSIGNED: Despite the limited number of observational studies available, our analysis suggests that the use of SGLT2 inhibitors by type 2 diabetes patients during Ramadan does not appear to significantly impact kidney function.