The DAR 2020 Global survey : Ramadan fasting during COVID 19 pandemic and the impact of older age on fasting among adults with Type 2 diabetes

Hassanein, Mohamed; Hussein, Zanariah; Shaltout, Inass; Juani Wan Seman, Wan; Chin Voon, Tong; Mohd Noor, Nurain; Akif Buyukbese, Mehmet; El Tony, Lobna; Mohamed Shaker, Gamal; Alamoudi, Reem M.; Hafidh, Khadija; Fariduddin, M.; Batais, Mohammed A.; Shaikh, Shehla; Rachid Malek, Pr; Alabbood, Majid; Sahay, Rakesh; Alshenqete, Abdulwadod M.; Yakoob Ahmedani, Muhammad

Objectives The DAR Global surveyof Ramadan-fasting during the COVID-19 pandemic aimed to describe the characteristics and care in participants with type 2 diabetes (T2D)with a specific comparison between those < 65years and>65 years. Methods Participantswere consented to answer aphysician-administered questionnairefollowing Ramadan 2020. Impact of COVID-19 on the decision of fasting,intentions to fast and duration of Ramadan and Shawalfasting, hypoglycaemia and hyperglycaemia eventswere assessed. Specific analysis comparing age categories of <65 years and>65years were performed. Results Among the 5865 participants, 22.5% were>65 years old. Concern for COVID-19 affected fasting decisionfor 7.6% (> 65years) vs 5.4% (<65years). More participants >65 years old did not fast (28.8% vs 12.7%,<65 years). Of the 83.6%, participantsfulfillingRamadan-fasting, 94.8%fasted >15 days and 12.6% had to break fast due to diabetes-related illness.The average number of days fasting within and post-Ramadan were 27 and 6 days respectively, regardless of age. Hypoglycaemia and hyperglycaemia occurred in 15.7% and 16.3% of participants respectively,with 6.5% and 7.4% requiringhospital care respectively. SMBGwas performed in 73.8% of participants and 43.5% received Ramadan-focused education. Conclusion During the COVID-19 pandemic, universally high rates of Ramadan-fasting were observedregardless of fasting risk level.Glycemic complications occurred frequently witholder adults requiring higher rates of acute hospital care. Risk stratification is essential followed bypre-Ramadan interventions, Ramadan-focused diabetes education and self-monitoringto reduce and prevent complications, with particular emphasis in older adults.