Management of diabetes during fasting and COVID-19 - Challenges and solutions

Waseem N Ahmed; Chankramath S Arun; Thanuvelil G Koshy; Abilash Nair; Prasanth Sankar; Sabeer A Rasheed; Reeja Ann

doi:10.4103/jfmpc.jfmpc_845_20

Management of diabetes during fasting and COVID-19 - Challenges and solutions

J Family Med Prim Care. 2020 Aug 4;9(8):3797-3806. doi: 10.4103/jfmpc.jfmpc_845_20. eCollection 2020 Aug.

Authors

Waseem N Ahmed¹, Chankramath S Arun², Thanuvelil G Koshy³, Abilash Nair⁴, Prasanth Sankar⁵, Sabeer A Rasheed⁶, Reeja Ann⁷

Affiliations

¹ Department of Family and Internal Medicine, CRAFT Hospital and Research Centre, Kodungallur, Thrissur, Kerala, India.
² Department of Endocrinology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
³ Department of Medicine, MOSC (Malankara Orthodox Syrian Church Medical College), Kolencherry, Ernakulam, Kerala, India.
⁴ Department of Endocrinology, Govt. Medical College, Thiruvananthapuram, Kerala, India.
⁵ Department of Internal Medicine and Diabetes, MGM Muthoot Hospitals, Pathanamthitta, Kerala, India.
⁶ Dr Rasheed's Diabetic Specialty Center, Thiruvananthapuram, Kerala, India.
⁷ Medical Officer, Govt Taluk Hospital, North Paravur, Ernakulam, Kerala, India.

Abstract

Introduction: Fasting is observed as a religious custom in various forms across the globe. Among them, the Ramadan fasting is very common and widely practiced. People with diabetes observe fasting with or without obtaining medical advice. Uncontrolled diabetes appears to be a risk factor for COVID-19 infection and its poorer outcomes. Fasting during Ramadan is challenging in people with diabetes. This year, the background of COVID-19 made it difficult for both the patients and health care workers to effectively manage diabetes and its complications during Ramadan. Because of a lack of sufficient evidence, clinicians were perplexed in handling this difficult situation.

Materials and methods: We accessed PubMed, Google Scholar, various guidelines and other evidence-based articles to review the available current literature which deals with diabetes, Ramadan, and COVID-19.

Results: The importance of pre-Ramadan assessment, adequate nutrition, and hydration, choosing the right therapy has been emphasized. This review tries to address the common practical challenges and relevant possible solutions for the same. Due consideration has been given to various socio-cultural practices that can influence the management of diabetes patients in the setting of Ramadan and COVID-19 pandemic.

Conclusions: Diabetes is associated with increased severity and susceptibility to COVID-19. People with diabetes should go through systemic and structure-based management during fasting. Family physicians who deliver personalized care play a vital role in managing diabetes during this crisis period. Telemedicine is emerging as an effective mode of managing various needs of individuals.

Keywords: COVID-19; India; Ramadan; diabetes; fasting; primary care physician.