IMPACT OF STRUCTURED EDUCATION

ON SAFE FASTING

EGYPTIAN STUDY

Mesbah Sayed Kamel

MD

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

Hypoglycemic episodes.

Blood glucose self monitoring.

Glycemic control.

Fast break frequency.

END POINTS

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

METHODOLOGY

Randomized controlled clinical trail

conducted to Muslim diabetic patients

during the period from April 2014to August

2014.

STUDY DESIGN

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,..).

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.

10%20

%

30

%

40

%

50%60

%

70%80%90%100%-:العمر

ذكر انثى -:النوع

النوع األول النوع الثانى سكر حمل

ال اعلم

ماهو نوع مرض السكر لديك ؟

سنة......... منذ متى وانت مريض بالسكر؟

أقراص ( منذ متى) إنسولين

اإلثنين معا

ماهو نوع العالج الذى تستخدمه لعالج السكر؟

من فضلك إكتب نوع عالج السكر الذى تستخدمه

نعم ال هل صمت رمضان السنة الماضية؟

نعم ال

كم عدد االيام التى افطرتها؟. لو نعم

ن هل أفطرت فى رمضان السنة الماضية نتيجة مشاكل م

السكر؟

نعم ال هل سبق أن حضرت ندوة عن السكروالصيام؟

نعم ال هل تأخذ األقراص او اإلنسولين فى رمضان فى مواعيد

وبجرعات مختلفة مقارنة بالشهور اإلخرى؟

قبل رمضان بداية الدراسة( 1)إستبيان عن رمضان والسكر

.السكرفي أثناء الصيام بدون حدوث إرتفاع او إنخفاض شديد فى فى الدمالسكرمستوى من المهم ضبط

:ما هي المعدالت اآلمنة للسكر

صائم بعد األكل بساعتين السكر التراكمي

الصيام بامانحدد مدى ثقتك على

نعم ال ن هل تأخذ األقراص او اإلنسولي

فى رمضان فى مواعيد

وبجرعات مختلفة مقارنة

بالشهور اإلخرى؟

زادت قلت كما هى توقف العالج هل( األقراص او اإلنسولين)لو نعم

-:تغيرت جرعتك

عدد المرات خالل االسبوع:نعم

ال/

ر هل تقيس السكر بالدم خالل شه

رمضان؟

ماهي المواعيد التي تقيس فيها

أثناء الصيام

(حدد الساعة)كم مرة متي :نعم

ال/

هل سبق وأن كان معدل السكر

خالل شهر رمضان70بالدم أقل من

أو عانيت من أى عرض من أعراض

-الدوار-الهبوط السكرى كالدوخة

-العرق -سرعة دقات القلب

ااالحساس بالجوع او عدم التركيز؟

ال/ نعم عندما إنخفض معدل سكرك هل

أفطرت؟

اذا لم تفطر ماذا حدث؟

نعم كم مرة

ال/

هل إنخفض معدل السكر لديك قبل

رمضان؟

هل تزور طبيبك قبل رمضان

ال/نعم هل سبق أن دخلت المستشفى

بسبب السكر خالل رمضان؟

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.

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.

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.

DAR SAFE FASTING DIARYY

مفكرة قياس السكر بالدم-( صوم آمن)برنامج دار

RESULTS

PRE-ASSESSMENT 167 PATIENTS

BUT WHAT SORT OF EDUCATION?/

Blood glucose parameters knowledge

NO DEFINITE ASSESSMENT OF THIS ABILITY

MORE THAN 94% FAST

DIVERSITY OF TTT REGIMENS NEED TO BE

CONSIDERED

REGARDLESS THE GLYCEMIC CONTROL!!!

IGNORING HYPERGLYCEMIA!!!

INSIST TO FAST WHATEVER THE RISKS

60% NO MONITORING,40% INFREQUENT

MONITORING

HIGH RISK OF HYPOGLYCEMIA

SOHOR IS GOOD BUT TIMING IS

IMPORTANT

DR VISIT BEFORE RAMADAN:GOLDEN

CHANCE FOR EDUCATION BUT WHEN AND

WHAT CONTENT???

POST –ASSESSMENT 97 PATIENTS

IMPACT OF STRUCTURED

EDUCATION:SMBG

NOT ONLY MONITORING BUT A

PERFECT ONE

FREQUENT MONITORING IS POSSIBLE!!

HOT LINE MUST BE AVAILABLE

MONITORING WILL BE A HABBIT

MORE CONFIDENCE IN SAFE FASTING

DIABETES IS A TRUE FAST-RISK !!!!

DOCUMENTED HYPOGLYCEMIA

تسجيل نوبات الهبوط ورد الفعلIMPACT OF EDUCATION:

BEHAVIORAL CHANGES WERE DRAMATIC

CONTINOUS EDUCATION IS

NECESSARY

IMPACT OF STRUCTURED EDUCATION

MORE GLYCEMIC CONTROL

CONTINUOUS MONITORING AND

CONSULTATION RESULTED IN GLYCEMIC

IMPROVEMENT

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.

ACKNOWLEDGEMENT

Upper Egypt DAR Group:

Adel Elsayed

Sara Mesbah Kamel.

Mohamed Mashahit.

Delta DAR Group:

Wael Farrag.

Ingy Abdel Wahab.

Yasser Abdel Raoof.