{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T21:38:27Z","timestamp":1791927507517,"version":"4.3.4"},"reference-count":22,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2019,2,11]],"date-time":"2019-02-11T00:00:00Z","timestamp":1549843200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/ijerph16030499","type":"journal-article","created":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T03:18:20Z","timestamp":1549941500000},"page":"499","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Exploring Drug-Related Problems in Diabetic Patients during Ramadan Fasting in Saudi Arabia: A Mixed-Methods Study"],"prefix":"10.3390","volume":"16","author":[{"given":"Waleed Saleh","family":"Alluqmani","sequence":"first","affiliation":[{"name":"College of Pharmacy, Umm al-Qura University, Taif Road, Makkah 24381, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Misri","family":"Alotaibi","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Umm al-Qura University, Taif Road, Makkah 24381, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waleed Jamal","family":"Almalki","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Umm al-Qura University, Taif Road, Makkah 24381, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrahman","family":"Althaqafi","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Umm al-Qura University, Taif Road, Makkah 24381, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamed Abdullah","family":"Alawi","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Umm al-Qura University, Taif Road, Makkah 24381, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahad","family":"Althobiani","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Umm al-Qura University, Taif Road, Makkah 24381, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amjad Abdullah","family":"Albishi","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Umm al-Qura University, Taif Road, Makkah 24381, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amjad Ahmad","family":"Madkhali","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Umm al-Qura University, Taif Road, Makkah 24381, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Layal Yahia","family":"Baunes","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Umm al-Qura University, Taif Road, Makkah 24381, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Razan Ibrahim","family":"Alhazmi","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Umm al-Qura University, Taif Road, Makkah 24381, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaf Mohammed","family":"Doman","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Umm al-Qura University, Taif Road, Makkah 24381, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anwar Hussain","family":"Alhazmi","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Umm al-Qura University, Taif Road, Makkah 24381, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majid","family":"Ali","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Umm al-Qura University, Taif Road, Makkah 24381, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ejaz","family":"Cheema","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Umm al-Qura University, Taif Road, Makkah 24381, Saudi Arabia"},{"name":"Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,2,11]]},"reference":[{"key":"ref_1","unstructured":"Centers for Disease Control and Prevention (2017). National Diabetes Statistics Report, 2017."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"359","DOI":"10.2174\/1573399811666150724095130","article-title":"Diabetes Mellitus in Saudi Arabia: A Review of the Recent Literature","volume":"12","author":"Robert","year":"2016","journal-title":"Curr. Diabetes Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/1475-2891-9-57","article-title":"The impact of religious fasting on human health","volume":"9","author":"Trepanowski","year":"2010","journal-title":"Nutr. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1177\/1715163517700840","article-title":"Managing medications during Ramadan fasting","volume":"150","author":"Grindrod","year":"2017","journal-title":"Can. Pharm. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2306","DOI":"10.2337\/diacare.27.10.2306","article-title":"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","volume":"27","author":"Salti","year":"2004","journal-title":"Diabetes Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1136\/bmj.329.7469.778","article-title":"Drug intake during Ramadan","volume":"329","author":"Aadil","year":"2004","journal-title":"BMJ"},{"key":"ref_7","unstructured":"Pharmaceutical Care Network Europe (2019, January 29). Classification of Drug Related Problems. Available online: https:\/\/www.pcne.org\/upload\/files\/230_PCNE_classification_V8-02.pdf."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1111\/j.1464-5491.2011.03563.x","article-title":"Ramadan prospective diabetes study: The role of drug dosage and timing alteration, active glucose monitoring and patient education","volume":"29","author":"Ahmedani","year":"2012","journal-title":"Diabet. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1007\/s00125-008-1220-8","article-title":"Ramadan-focused education and awareness in type 2 diabetes","volume":"52","author":"Hassanein","year":"2009","journal-title":"Diabetologia"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.1111\/hex.12163","article-title":"Having diabetes and having to fast: A qualitative study of British Muslims with Diabetes","volume":"18","author":"Patel","year":"2015","journal-title":"Health Expect."},{"key":"ref_11","first-page":"99","article-title":"\u201cEach one is a doctor for herself\u201d: Ramadan fasting among pregnant Muslim women in the United States","volume":"15","author":"Robinson","year":"2005","journal-title":"Ethn. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1007\/s11096-011-9542-x","article-title":"Drug-related problems in diabetes and transplant patients: An observational study with home visits","volume":"33","author":"Eichenberger","year":"2011","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.diabres.2012.03.003","article-title":"Medication-related problems occurring in people with diabetes during an admission to an adult teaching hospital: A retrospective cohort study","volume":"97","author":"Manias","year":"2012","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1186\/1471-2458-13-1192","article-title":"Drug-related problems in type 2 diabetes mellitus patients with dyslipidemia","volume":"13","author":"Huri","year":"2013","journal-title":"BMC Public Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1007\/s10900-014-9854-6","article-title":"Neighborhood Perceptions and Health-Related Outcomes Among Latinos with Diabetes from a Rural Agricultural Community","volume":"39","author":"Moreno","year":"2014","journal-title":"J. Community Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual. Res. Psychol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.2337\/dc10-0896","article-title":"Recommendations for management of diabetes during Ramadan: Update 2010","volume":"33","author":"Arouj","year":"2010","journal-title":"Diabetes Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1258\/jrsm.2010.090254","article-title":"Review of diabetes management and guidelines during Ramadan","volume":"103","author":"Karamat","year":"2010","journal-title":"J. R. Soc. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s11096-012-9716-1","article-title":"Patient perspectives on type 2 diabetes and medicine use during Ramadan among Pakistanis in Denmark","volume":"35","author":"Mygind","year":"2013","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1111\/j.1365-2702.2007.02099.x","article-title":"Diabetes: A cross-cultural interview study of immigrants from Somalia","volume":"16","author":"Wallin","year":"2007","journal-title":"J. Clin. Nurs."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1080\/13557858.2010.523780","article-title":"Health is a spiritual thing: Perspectives of health care professionals and female Somali and Bangladeshi women on the health impacts of fasting during Ramadan","volume":"16","author":"Pathy","year":"2011","journal-title":"Ethn. Health"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Helman, C.G. (2007). Doctor-patient Interactions. Culture, Health and Illness, Hodder Arnold. [5th ed.].","DOI":"10.1201\/b13281"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/3\/499\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:31:06Z","timestamp":1760185866000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/3\/499"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2,11]]},"references-count":22,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2019,2]]}},"alternative-id":["ijerph16030499"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16030499","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,2,11]]}}}