{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:41:24Z","timestamp":1790800884243,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,11,29]],"date-time":"2023-11-29T00:00:00Z","timestamp":1701216000000},"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":["Clinical Endocrinology"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Once daily prednisolone taken at predawn has been proposed to be the glucocorticoid replacement of choice in patients with adrenal insufficiency (AI) who intend to fast for the month of Ramadan. However, the effects of prednisolone on metabolic parameters and quality of life during fasting for Ramadan are unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Patients and Measurements<\/jats:title><jats:p>Patients with AI on twice\u2010daily hydrocortisone, who had low or moderate risk and intended to fast, were recruited. Patients were converted to prednisolone 5\u2009mg once daily taken at sahur (predawn) and Ramadan education given. Weight, sleep duration, biochemical parameters\u00a0and quality of life measures (SF\u201036 questionnaire) were analysed at the end of Ramadan and compared against baseline.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty patients (13 men) were recruited, with a mean age of 59.9\u2009\u00b1\u200915.0 years. All patients were on hydrocortisone 15\u2009mg daily (in divided doses) as pre\u2010Ramadan glucocorticoid replacement. Half had type 2 diabetes with low IDF\u2010DAR risk. Eighty\u2010five percent\u00a0of patients completed the full 29 days of fasting with no complications. There was a significant reduction in weight (\u22121.1\u2009\u00b1\u20091.6\u2009kg, <jats:italic>p<\/jats:italic>\u2009=\u2009.005), with no significant change in blood pressure or sleep duration. There was a significant increase in urea (0.80\u2009\u00b1\u20091.1\u2009mmol\/L, <jats:italic>p<\/jats:italic>\u2009=\u2009.005) and haematocrit, (0.011\u2009\u00b1\u20090.019 L\/L, <jats:italic>p<\/jats:italic>\u2009=\u2009.019) and decrease in serum sodium (\u22121.6\u2009\u00b1\u20093.0\u2009mmol\/L, <jats:italic>p<\/jats:italic>\u2009=\u2009.028), with no change in serum creatinine or liver function. Quality of life measures were preserved in all domains with significant improvement in role limitation due to physical health (15.3\u2009\u00b1\u200921.6, <jats:italic>p<\/jats:italic>\u2009=\u2009.005) and bodily pain (8.8\u2009\u00b1\u200916.3, <jats:italic>p<\/jats:italic>\u2009=\u2009.031).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study has demonstrated that converting patients with AI who are fasting for Ramadan from twice\u2010daily hydrocortisone to prednisolone 5\u2009mg daily at sahur was safe, with no major short\u2010term adverse effects. Despite the higher equivalent glucocorticoid doses, patients experienced weight loss and no clinically significant change in blood pressure, sleep, biochemical parameters or quality of life. This study paves the way to trial even lower doses of prednisolone once daily in patients fasting for Ramadan with AI.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.14999","type":"journal-article","created":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T04:54:40Z","timestamp":1701320080000},"page":"221-229","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The use of prednisolone during Ramadan fasting in patients with adrenal insufficiency"],"prefix":"10.1111","volume":"100","author":[{"given":"Nicholas Ken Yoong","family":"Hee","sequence":"first","affiliation":[{"name":"Endocrine Unit, Department of Medicine, Faculty of Medicine University Malaya Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quan Hziung","family":"Lim","sequence":"additional","affiliation":[{"name":"Endocrine Unit, Department of Medicine, Faculty of Medicine University Malaya Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharmila","family":"Paramasivam","sequence":"additional","affiliation":[{"name":"Endocrine Unit, Department of Medicine, Faculty of Medicine University Malaya Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee Ling","family":"Lim","sequence":"additional","affiliation":[{"name":"Endocrine Unit, Department of Medicine, Faculty of Medicine University Malaya Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shireene","family":"Vethakkan","sequence":"additional","affiliation":[{"name":"Endocrine Unit, Department of Medicine, Faculty of Medicine University Malaya Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shubash Shander","family":"Ganapathy","sequence":"additional","affiliation":[{"name":"Institute for Public Health National Institutes of Health, Ministry of Health Malaysia Shah Alam, Selangor Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4993-6470","authenticated-orcid":false,"given":"Jeyakantha","family":"Ratnasingam","sequence":"additional","affiliation":[{"name":"Endocrine Unit, Department of Medicine, Faculty of Medicine University Malaya Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,11,29]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"Pew Research Center.The Future of World Religions: Population Growth Projections 2010\u20132050. April 13 2015. Accessed February 17 \u00a02023.http:\/\/www.pewforum.org\/2015\/04\/02\/religious-projections-2010-2050\/"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.15605\/jafes.036.S21"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-016-1186-0"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2015-1710"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-08-0578"},{"key":"e_1_2_7_7_1","unstructured":"HassaneinM AfandiB AlaroujM et al.Risk Stratification of People with Diabetes before Ramadan. IDF\u2010DAR Practical Guidelines 2021. January 21 2021. 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National Library of Medicine. \u00a0January 8 2018. Accessed September 20 \u00a02023.https:\/\/clinicaltrials.gov\/study\/NCT03608943"},{"key":"e_1_2_7_32_1","unstructured":"Imperial College London.Safety and Efficacy of Prednisolone in Adrenal Insufficiency Disease (PRED\u2010AID Study) (PRED\u2010AID). National Library of Medicine. May 3 2019. 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