PreRamadan Structured Educational Intervention

Background

Ramadan is a month of fasting observed by millions of Muslims worldwide. For people with diabetes, fasting can pose serious health risks such as hypoglycaemia, hyperglycaemia, dehydration and ketoacidosis. Yet many patients choose to fast because of religious devotion, family expectations, or personal conviction. A structured preRamadan educational program bridges the gap between spiritual commitments and safe health management, empowering patients to make informed decisions and to adjust their therapy appropriately.

Program Objectives

• Increase patients knowledge about the physiological changes that occur during fasting.
• Enable individualized risk assessment and determination of fasting suitability.
• Provide practical guidance on medication adjustment, meal planning and glucose monitoring.
• Teach selfmanagement skills to prevent and treat hypoglycaemia or hyperglycaemia.
• Facilitate communication between patients, diabetologists, pharmacists and dietitians.
• Improve overall glycaemic control during Ramadan and reduce hospital admissions.

Program Components

1. Initial Assessment (46 weeks before Ramadan)

A brief medical review includes:

2. Risk Stratification

Patients are classified into low, moderate, high or very high risk according to international guidelines (e.g., IDFDAR, ADA). Highrisk individuals receive a recommendation not to fast, or to fast only under strict supervision.

3. Educational Sessions

Three interactive workshops are held weekly.

• Session 1 Physiology & Safety: What fasting does to glucose metabolism, signs of danger, when to break the fast.
• Session 2 Medication Management: Adjusting basalbolus insulin, sulfonylureas, SGLT2 inhibitors, etc.; importance of timing with Sahur (predawn meal) and Iftar (evening meal).
• Session 3 Nutrition & Lifestyle: Balanced Suhoor and Iftar menus, fluid intake, physical activity, sleep patterns.

4. Individualized Care Plan

After the workshops, each patient receives a written plan with:

• Target blood glucose ranges (e.g., 70120mg/dL preSuhoor, 140180mg/dL postIftar).
• Specific medication dose changes.
• Selfmonitoring schedule (e.g., fasting day: preSuhoor, midday, preIftar, postIftar).
• Emergency contact numbers.

5. Support Tools

• Printed booklet and QRlinked video tutorials.
• Mobile app reminder for glucose checks and medication times.
• WhatsApp/Telegram group for peer support and clinician Q&A.

Implementation Strategy

Team composition: diabetologist, endocrine nurse educator, dietitian, pharmacist, and a community religious leader.

Stepbystep workflow

1. Recruitment: Identify eligible patients during routine clinic visits or via community announcements.
2. Screening: Conduct risk assessment and chart review.
3. Invitation to workshops: Offer flexible timing (evening or weekend) to accommodate work schedules.
4. Distribution of materials: Hand out booklets, install the app, and enroll patients in the support group.
5. Followup calls: Telephone checkins on days 1, 7 and 14 of fasting to troubleshoot problems.
6. PostRamadan review: Evaluate outcomes, collect feedback and adjust the curriculum for the next year.

Program Evaluation

Key performance indicators (KPIs) are measured before, during and after Ramadan.

Data are analyzed quarterly and presented to the clinics qualityimprovement committee.

Additional Resources

• International Diabetes Federation Guidelines for Managing Diabetes During Ramadan
• American Diabetes Association Standards of Care chapter on fasting
• Local hospital diabetes education portal (link to resources)
• Video series: Fasting Safely with Diabetes (YouTube playlist)