KARACHI: The International Diabetes Federation (IDF) and Diabetes and Ramadan (DaR) have unveiled elaborate guidelines for the 148 million Muslims with diabetes worldwide, most of whom fast during Ramazan and generally face hardships due to lack of awareness about how to manage their illness with successful fasting.

The guidelines, spread over 144 pages, were launched in Dubai during the DaR International Alliance Conference in collaboration with IDF and Sanofi Middle East at Mohammad bin Rashid Academic Medical Centre in Dubai on Saturday.

Pakistan’s delegation of experts and officials was the largest of dozens of countries of the region who took part in the conference.

DaR chairman Mohammed Hassnaein and Pakistan’s Abdul Basit were among 31 authors and co-authors who drafted the book of guidelines.

During several scientific sessions and interactions with the media, the organisers said such guidelines were long awaited as the issue involved risks to life because of a host of serious complications that millions of Muslims with diabetes faced while fasting.

“It is culture issue for many people in Muslim countries who could not openly skip fasting because of their illness but we suggest to such people to break their fast immediately if they find decrease or increase in their sugar level,” said Mr Hassnaein.

The guidelines included a fatwa from Egypt’s Mufti, Prof Shawky Ibrahim Allam, who declared by citing Holy Quran and Hadith that if fast harms any person, as said by specialist physicians, then a patient of diabetes “must break the fast in order to save one’s health.”

“Allah Almighty says: ‘Let there be no compulsion in religion’. Allah Almighty also says ‘and make not your own hands contribute to (your) destruction’,” said the fatwa.

The Mufti said diabetes of all types, fell in chronic diseases. He said if the patient thought “if he fasts he will suffer, or if he fasts and suffers, where the illness gets tougher or he needs to take medications or he becomes very hungry or thirsty, as happens with most of the diabetics, then he is permitted to break the fast”.

“Furthermore, he must break the fast if he is afraid of serious harm, where Allah Almighty says ‘and do not kill yourselves [or one another]. Indeed, Allah is to you ever Merciful.”

Dr Shaukat Sadikot, president of IDF, said despite all measures death because of diabetes was on the rise. “In 2011, diabetes killed a person every seven seconds in the world, after five years we calculate a death every six seconds. Most deaths are recorded in the developing world,” he said.

Experts said with the worldwide prevalence of diabetes increasing, and the number of fasting Muslims set to rise, the importance of effective guidelines for the management of diabetes during Ramazan fasting was clear.

“With the correct guidance, many people with diabetes can fast safely during Ramazan but they must be under close supervision and be made aware of the risks,” said Dr Hisham Mahmoud, head of medical affairs for Sanofi Middle East and Turkey.

The document says pre-Ramazan education has been shown to reduce the incidence of hypoglycaemia (deficiency of glucose in blood stream). Different medications to treat diabetes have varying levels of hypoglycaemic risk, and Ramazan-specific treatment regimens should be produced for each patient.

Experts said prevalence of diabetes was increasing throughout the world with estimates suggesting there would be 642 million people with diabetes by 2040; this increase was predicted to be particularly marked in Muslim-majority countries. Estimates suggest that there are 148 million Muslims with diabetes worldwide and despite being exempt, the majority of Muslim patients with diabetes fast for at least half of the month of Ramazan. Many patients also fast at other times during the year.

They said the month of Ramazan could precipitate dramatic changes in meal schedule, sleep patterns and circadian rhythms. Ramazan fasting can be associated with favourable physiological changes among healthy individuals, such as decreased body weight and favourable changes in lipid profile.

In patients with diabetes, however, Ramazan fasting can be associated with certain risks due to the pathophysiology that disrupts normal glucose homeostatic mechanisms.

Experts said the risks associated with fasting included hypoglycaemia, hyperglycaemia, DKA, dehydration and thrombosis; physicians must quantify the risks and stratify each individual patient accordingly.

They said Islamic regulations had exempted from fasting those afflicted with illness. “Harmony between medical and religious advice is essential to ensure safe fasting for people with diabetes.

They spoke about Ramazan Nutrition Programme (RNP), which was a mobile and web-based application designed to help physicians individualize and implement the programme for patients with diabetes during Ramazan.

They identified several barriers to guideline implementation, originating within the individual or within the wider cultures of the community or healthcare system.

Published in Dawn, April 18th, 2016