{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T14:46:16Z","timestamp":1789569976304,"version":"build-2803163510"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T00:00:00Z","timestamp":1673395200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Metabolism Res"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fasting during the holy month of Ramadan is one of the five pillars of Islam. Fasting is not meant to create excessive hardship on the Muslim individual according to religious tenets. It is important that health professionals are aware of potential risks associated with fasting during the month of Ramadan (mainly hypoglycemia and hyperglycemia).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To explore the impact of applying the principles of our 2020 recommendations for the management of type 2 diabetes (T2D) during the month of Ramadan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multinational randomized controlled trial (RCT) was conducted in five Muslim majority countries. Six hundred and sixty participants were deemed eligible for the study; however, 23% declined to participate later for various reasons. In total, 506 participants were enroled and were equally randomized to the intervention or the control group. At the end of the study, data from 231 participants in the intervention group and 221 participants from the control group were collected after 12.6% and 8.7% were, respectively, lost to follow\u2010up. Participants were randomized to receive a Ramadan\u2010focussed education with treatment for diabetes adjusted as per our 2020 recommendation update compared with the local usual care (control group). Results are presented using mean, standard deviation, odds ratio (OR), and percentages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At the end of the study, the number of hypoglycemic episodes in the intervention group was less than in participants who received usual care. The intervention group had significantly lower severe hypoglycemia compared to the control group with an OR of 0.2 [0.1\u20130.8]. Compared to baseline, both groups had a significant reduction in glycated haemoglobin (HbA1c), but the improvements were significantly greater in the intervention group. Whilst body weight reduced and high\u2010density lipoprotein cholesterol increased with the intervention, these changes were not significantly different from usual care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A pre\u2010Ramadan assessment of people with T2D coupled with pre\u2010Ramadan education and an adjustment of glucose\u2010lowering treatment as per our updated 2020 recommendations can prevent acute complications and allow a safer fast for people with T2D. We have shown that such an approach reduces the risk of developing severe hypoglycemia and improves the metabolic outcomes in people with T2D.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/dmrr.3604","type":"journal-article","created":{"date-parts":[[2022,12,22]],"date-time":"2022-12-22T10:06:01Z","timestamp":1671703561000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Optimizing Ramadan fasting: A randomised controlled trial for people with type 2 diabetes during Ramadan applying the principles of the ADA\/EASD consensus"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4460-9849","authenticated-orcid":false,"given":"Mahmoud","family":"Ibrahim","sequence":"first","affiliation":[{"name":"EDC Centre for Diabetes Education  Charlotte North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Moffett","family":"Barker","sequence":"additional","affiliation":[{"name":"Diabetes Research Centre University of Leicester  Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1359-9337","authenticated-orcid":false,"given":"Ehtasham","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Diabetes Research Centre University of Leicester  Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asma","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Agha Khan University Hospital  Karatchi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Firas A.","family":"Annabi","sequence":"additional","affiliation":[{"name":"Islamic Hospital  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebtesam M.","family":"Ba\u2010Essa","sequence":"additional","affiliation":[{"name":"Sumuo Medical Centre  Dammam Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie J.","family":"Davies","sequence":"additional","affiliation":[{"name":"Diabetes Research Centre University of Leicester  Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6628-4726","authenticated-orcid":false,"given":"Pamela","family":"Houeiss","sequence":"additional","affiliation":[{"name":"Medical Faculty Paris University  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hinde","family":"Iraqi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy Department of Endocrinology Mohamed V University  Rabat Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shabeen Naz","family":"Masood","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Isra University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safia","family":"Mimouni\u2010Zerguini","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetology &amp; 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