COVID-19, diabetes and Ramadan
EASD e-Learning’s latest module takes a fresh look at Ramadan guidance for people with diabetes, this time through the lens of COVID-19. The module explores how the risks of Ramadan fasting have been exacerbated during the pandemic – and why adhering to guidelines for safe fasting is vital, now more than ever.
One of the most important tenets of Islam is the sanctity of human life, a point strongly emphasised by Professor Wasim Hanif in his new module, COVID-19, diabetes and Ramadan, which launches this week.
“We are in a situation where we have got one of the biggest pandemics that we have seen in a lifetime,” he says. “Millions of people have died around the world. So it is imperative that each one of us, both healthcare professionals as well as patients, look after themselves. The purpose of this module is to help patients as well as healthcare professionals to fast safely if they choose to do so. But at the same time realising that in some situations they may not be able to fast. Based on robust evidence, we have tried to come up with a guideline that not only covers fasting during Ramadan, but also looks at how patients can fast safely if they choose to do so during the COVID-19 pandemic.”
Wasim is also at pains to point out the particular jeopardy COVID-19 poses to people with diabetes, describing the relationship between the two as “a perfect storm.” He calls it “a collision and collusion of two diseases” owing to the parallels between them. “COVID-19 as we all know is marked by an acute cytokine storm, causing a cytokine surge, while diabetes is a chronic low-grade inflammation. COVID-19 causes acute damage of the kidneys. It causes a hypercoagulable state and can cause acute respiratory distress syndrome. While diabetes can cause a chronic damage of the kidneys, it does cause a hypercoagulable state and it can also have an effect on the brain function. Both these conditions cause endothelial dysfunction and can have the same consequences.”
As a consequence, as has now been all too well established, people with type 2 diabetes have nearly twice the risk of dying from COVID-19 when compared to those without type 2 diabetes. And people with type 1 diabetes have nearly 3.5-fold risk of dying from COVID-19 when compared to people without type 1 diabetes. Against such a backdrop, consideration of COVID-19 must inflect every aspect of the advice we give to people with diabetes who wish to fast safely during Ramadan – from use of glucose-lowering therapies such as SLGT-2 inhibitors to choices around diet and exercise. And, of course, the way we calculate the risks of Ramadan fasting to people with diabetes.
But while the pandemic context adds new layers of complexity, the key message remains a simple one: an individualised, patient-centred treatment planis essential to not only achieve optimal glycaemic outcomes but also enable people with diabetes to observe a risk-free month of fasting during Ramadan.