1. IMPACT OF STRUCTURED EDUCATION
ON SAFE FASTING
EGYPTIAN STUDY
Mesbah Sayed Kamel
MD

2. To assess the diabetes-fasting related issues of
diabetic patients before Ramadan and the impact
of structured education on safe fasting and post
Ramadan assessment.This study was conducted in
Minia governorate,an upper Egypt one 250 km
south Cairo.
AIM OF THE WORK

3. Hypoglycemic episodes.
Blood glucose self monitoring.
Glycemic control.
Fast break frequency.
END POINTS

4. Following the ethical guidelines of
epidemiological research, informed written
consent was taken from all participants after
supplying comprehensive information about the
nature of the study and the procedural details of
the blood sugar investigations.
ETHICAL CONSIDERATION

5. METHODOLOGY

6. Randomized controlled clinical trail
conducted to Muslim diabetic patients
during the period from April 2014to August
2014.
STUDY DESIGN

7. Inclusion criteria:
Muslim diabetic patients.
Exclusion criteria:
-Diabetics with co- morbidities
e.g:CKD,IHD, decompensated liver disease.
-Uncontrolled Diabetes (Taking insulin more
than two times).
-Has a religious exempt(ill,pregnant,..).

8. 2 months before Ramadan pre-assessment of
patient knowledge about diabetes and fasting
using a standardized questionnaire filled by
patients or their relatives after explaining each
item in simple meaningful words.

9. 10%20
%
30
%
40
%
50%60
%
70%80%90%100%
‫العمر‬:-
‫انثى‬ ‫ذكر‬ ‫النوع‬:-
‫حمل‬ ‫سكر‬ ‫الثانى‬ ‫النوع‬ ‫األول‬ ‫النوع‬
‫اعلم‬ ‫ال‬
‫؟‬ ‫لديك‬ ‫السكر‬ ‫مرض‬ ‫نوع‬ ‫ماهو‬
.........‫سنة‬ ‫بالسكر؟‬ ‫مريض‬ ‫وانت‬ ‫متى‬ ‫منذ‬
‫إنسولين‬(‫متى‬ ‫منذ‬)‫أقراص‬
‫معا‬ ‫اإلثنين‬
‫السكر؟‬ ‫لعالج‬ ‫تستخدمه‬ ‫الذى‬ ‫العالج‬ ‫نوع‬ ‫ماهو‬
‫تستخدمه‬ ‫الذى‬ ‫السكر‬ ‫عالج‬ ‫نوع‬ ‫إكتب‬ ‫فضلك‬ ‫من‬
‫ال‬ ‫نعم‬ ‫الماضية؟‬ ‫السنة‬ ‫رمضان‬ ‫صمت‬ ‫هل‬
‫ال‬ ‫نعم‬
‫نعم‬ ‫لو‬.‫افطرتها؟‬ ‫التى‬ ‫االيام‬ ‫عدد‬ ‫كم‬
‫م‬ ‫مشاكل‬ ‫نتيجة‬ ‫الماضية‬ ‫السنة‬ ‫رمضان‬ ‫فى‬ ‫أفطرت‬ ‫هل‬‫ن‬
‫السكر؟‬
‫ال‬ ‫نعم‬ ‫السكروالصيام؟‬ ‫عن‬ ‫ندوة‬ ‫حضرت‬ ‫أن‬ ‫سبق‬ ‫هل‬
‫ال‬ ‫نعم‬ ‫مواعيد‬ ‫فى‬ ‫رمضان‬ ‫فى‬ ‫اإلنسولين‬ ‫او‬ ‫األقراص‬ ‫تأخذ‬ ‫هل‬
‫اإلخرى؟‬ ‫بالشهور‬ ‫مقارنة‬ ‫مختلفة‬ ‫وبجرعات‬
‫والسكر‬ ‫رمضان‬ ‫عن‬ ‫إستبيان‬(1)‫الدراسة‬ ‫بداية‬ ‫رمضان‬ ‫قبل‬
‫ضبط‬ ‫المهم‬ ‫من‬‫مستوى‬‫السكر‬‫الدم‬ ‫فى‬‫فى‬ ‫شديد‬ ‫إنخفاض‬ ‫او‬ ‫إرتفاع‬ ‫حدوث‬ ‫بدون‬ ‫الصيام‬ ‫أثناء‬ ‫في‬‫السكر‬.
‫للسكر‬ ‫اآلمنة‬ ‫المعدالت‬ ‫هي‬ ‫ما‬:
‫التراكمي‬ ‫السكر‬ ‫بساعتين‬ ‫األكل‬ ‫بعد‬ ‫صائم‬
‫على‬ ‫ثقتك‬ ‫مدى‬ ‫حدد‬‫بامان‬ ‫الصيام‬

10. ‫ال‬ ‫نعم‬ ‫اإلنسولي‬ ‫او‬ ‫األقراص‬ ‫تأخذ‬ ‫هل‬‫ن‬
‫مواعيد‬ ‫فى‬ ‫رمضان‬ ‫فى‬
‫مقارنة‬ ‫مختلفة‬ ‫وبجرعات‬
‫اإلخرى؟‬ ‫بالشهور‬
‫العالج‬ ‫توقف‬ ‫هى‬ ‫كما‬ ‫قلت‬ ‫زادت‬ ‫نعم‬ ‫لو‬(‫اإلنسولين‬ ‫او‬ ‫األقراص‬)‫هل‬
‫جرعتك‬ ‫تغيرت‬:-
‫نعم‬:‫االسبوع‬ ‫خالل‬ ‫المرات‬ ‫عدد‬
/‫ال‬
‫شه‬ ‫خالل‬ ‫بالدم‬ ‫السكر‬ ‫تقيس‬ ‫هل‬‫ر‬
‫رمضان؟‬
‫فيها‬ ‫تقيس‬ ‫التي‬ ‫المواعيد‬ ‫ماهي‬
‫الصيام‬ ‫أثناء‬
‫نعم‬:‫متي‬ ‫مرة‬ ‫كم‬(‫الساعة‬ ‫حدد‬)
/‫ال‬
‫السكر‬ ‫معدل‬ ‫كان‬ ‫وأن‬ ‫سبق‬ ‫هل‬
‫من‬ ‫أقل‬ ‫بالدم‬70‫رمضان‬ ‫شهر‬ ‫خالل‬
‫أعراض‬ ‫من‬ ‫عرض‬ ‫أى‬ ‫من‬ ‫عانيت‬ ‫أو‬
‫كالدوخة‬ ‫السكرى‬ ‫الهبوط‬-‫الدوار‬-
‫القلب‬ ‫دقات‬ ‫سرعة‬-‫العرق‬-
‫التركيز؟‬ ‫عدم‬ ‫او‬ ‫بالجوع‬ ‫ااالحساس‬
‫نعم‬/‫ال‬ ‫هل‬ ‫سكرك‬ ‫معدل‬ ‫إنخفض‬ ‫عندما‬
‫أفطرت؟‬
‫حدث؟‬ ‫ماذا‬ ‫تفطر‬ ‫لم‬ ‫اذا‬
‫مرة‬ ‫كم‬ ‫نعم‬
/‫ال‬
‫قبل‬ ‫لديك‬ ‫السكر‬ ‫معدل‬ ‫إنخفض‬ ‫هل‬
‫رمضان؟‬
‫رمضان‬ ‫قبل‬ ‫طبيبك‬ ‫تزور‬ ‫هل‬
‫نعم‬/‫ال‬ ‫المستشفى‬ ‫دخلت‬ ‫أن‬ ‫سبق‬ ‫هل‬

11. After pre-assessment the participants were
subdivided into small groups (15-20 participants)
and received 2hour session of structured
education focused on Ramadan fasting and
diabetes knowledge. The sessions were given by
principal investigator and/or his trained assistants
(physicians) under his strict supervision.

12. Education program followed the structured diabetes
educational IDF module including meal planning,
physical activity, hypoglycemia, timing and dosage of
medications and glucose monitoring. Necessary
modifications made for the module to fit for important
aspects in Ramadan e.g. time for glucose checking,
accepted blood glucose levels and clarification that
glucose check does not break fasting.

16. Patients participating in the program were given a
glucometer and diary for blood glucose self-
monitoring and educated for (SMBG), according to
the following schedule: 9h after sohour, 2 hours before
Iftar and 2hours after Iftar. Also pt .advised to register
hypoglycemic episodes.
Post Ramadan assessment were done for 97
participants.

17. DAR SAFE FASTING DIARYY
‫دار‬ ‫برنامج‬(‫آمن‬ ‫صوم‬)-‫بالدم‬ ‫السكر‬ ‫قياس‬ ‫مفكرة‬

18. RESULTS

19. PRE-ASSESSMENT 167 PATIENTS

21. BUT WHAT SORT OF EDUCATION?/

22. Blood glucose parameters knowledge

23. NO DEFINITE ASSESSMENT OF THIS ABILITY

24. MORE THAN 94% FAST

25. DIVERSITY OF TTT REGIMENS NEED TO BE
CONSIDERED

26. REGARDLESS THE GLYCEMIC CONTROL!!!
IGNORING HYPERGLYCEMIA!!!

27. INSIST TO FAST WHATEVER THE RISKS

28. 60% NO MONITORING,40% INFREQUENT
MONITORING

29. HIGH RISK OF HYPOGLYCEMIA

30. SOHOR IS GOOD BUT TIMING IS
IMPORTANT

31. DR VISIT BEFORE RAMADAN:GOLDEN
CHANCE FOR EDUCATION BUT WHEN AND
WHAT CONTENT???

32. POST –ASSESSMENT 97 PATIENTS

33. IMPACT OF STRUCTURED
EDUCATION:SMBG

34. NOT ONLY MONITORING BUT A
PERFECT ONE

35. FREQUENT MONITORING IS POSSIBLE!!

36. HOT LINE MUST BE AVAILABLE

37. MONITORING WILL BE A HABBIT

38. MORE CONFIDENCE IN SAFE FASTING

39. DIABETES IS A TRUE FAST-RISK !!!!

40. DOCUMENTED HYPOGLYCEMIA

41. ‫الفعل‬ ‫ورد‬ ‫الهبوط‬ ‫نوبات‬ ‫تسجيل‬
IMPACT OF EDUCATION:
BEHAVIORAL CHANGES WERE DRAMATIC

42. CONTINOUS EDUCATION IS
NECESSARY

43. IMPACT OF STRUCTURED EDUCATION
MORE GLYCEMIC CONTROL

45. CONTINUOUS MONITORING AND
CONSULTATION RESULTED IN GLYCEMIC
IMPROVEMENT

46. CONCLUSIONS
Fasting is a spiritual issue for which patients make their own
decision after receiving appropriate advice from religious
teachings and from health care providers.
Frequent monitoring of glycemia: is essential multiple times daily.
 Structured education for patients fasting Ramadan is very
important not only during Ramadan but also throughout the year
for better management of diabetes.
This structured education should also extend to those who do not
wish to fast because they often are exposed to the risk of hypo-
and hyperglycemia during Ramadan as a reflection of social
habits encountered during the month.

47. ACKNOWLEDGEMENT
Upper Egypt DAR Group:
Adel Elsayed
Sara Mesbah Kamel.
Mohamed Mashahit.
Delta DAR Group:
Wael Farrag.
Ingy Abdel Wahab.
Yasser Abdel Raoof.