213 research outputs found
A population-based study of diabetes and its characteristics during the fasting month of ramadan in 13 countries: Results of the epidemiology of diabetes and ramadan 1422-2001 (EPIDIAR) study
No full textOBJECTIVE - The aim of this study was to assess the characteristics and care of patients with diabetes in countries with a sizable Muslim population and to study diabetes features during Ramadan and the effect of fasting. RESEARCH DESIGN AND METHODS - This was a population-based, retrospective, transversal survey conducted in 13 countries. A total of 12,914 patients with diabetes were recruited using a stratified sampling method, and 12,243 were considered for the analysis. RESULTS - Investigators recruited 1,070 (8.7percent) patients with type 1 diabetes and 11,173 (91.3percent) patients with type 2 diabetes. During Ramadan, 42.8percent of patients with type 1 diabetes and 78.7percent with type 2 diabetes fasted for at least 15 days. Less than 50percent of the whole population changed their treatment dose (approximately one-fourth of patients treated with oral antidiabetic drugs [OADs] and one-third of patients using insulin). Severe hypoglycemic episodes were significantly more frequent during Ramadan compared with other months (type 1 diabetes, 0.14 vs. 0.03 episode-month, P = 0.0174; type 2 diabetes, 0.03 vs. 0.004 episode-month, P 0.0001). Severe hypoglycemia was more frequent in subjects who changed their dose of OADs or insulin or modified their level of physical activity. CONCLUSIONS - The large proportion of both type 1 and type 2 diabetic subjects who fast during Ramadan represent a challenge to their physicians. There is a need to provide more intensive education before fasting, to disseminate guidelines, and to propose further studies assessing the impact of fasting on morbidity and mortality.Akanji AO, 2000, EUR J CLIN NUTR, V54, P508, DOI 10.1038-sj.ejcn.1601047; Alwan A, 1992, World Health Stat Q, V45, P355; Mafauzy M, 1990, Med J Malaysia, V45, P14; Azizi F, 1998, INT J RAMADAN FASTIN, V2, P8; Azizi F, 1887, MED J IRI, V1, P38; BAGRAICIK N, 1994, 1 INT C HLTH RAM, P32; BELKHADIR J, 1993, BRIT MED J, V307, P292; BESSAOUD K, 1990, REV EPIDEMIOL SANTE, V38, P91; Bouguerra R, 1997, 2 INT C HLTH RAM, P33; CHEAH JS, 1990, ANN ACAD MED SINGAP, V4, P501; COCKRAM CS, 2000, KONG KONG MED J, V1, P43; DAVIDSON JC, 1979, BRIT MED J, V2, P1511; HAKKOU F, 1994, GASTROENTEROL CLIN B, V3, P190; HAOURI M, 1997, CIRCADIAN EVOLUTION, P31; HGOJLUND K, 2001, AM J PHYSIOL-ENDOC M, V1, pE50; *INT M DIAB RAM RE, 1995, HASS 2 FDN SCI MED R; Jonsson B, 2002, DIABETOLOGIA, V45, pS5, DOI 10.1007-s00125-002-0858-x; Kadiki OA, 1998, DIABETES METAB, V24, P424; Kadiri A, 2001, DIABETES METAB, V27, P482; Katibi I A, 2001, Niger J Med, V10, P132; KHOGHEER Y, 1987, ANN SAUDI MED S, V7, P5; King H, 1998, DIABETES CARE, V21, P1414, DOI 10.2337-diacare.21.9.1414; KING H, 1998, DIABETES CARE, V9, P414; KING H, 1993, DIABETES CARE, V16, P157, DOI 10.2337-diacare.16.1.157; MAFAUZY M, 1990, MED J MALAYSIA, V1, P14; NIAZI G, 1997, 2 INT C HLTH RAM, P24; Ramadan J, 1999, NUTRITION, V15, P735, DOI 10.1016-S0899-9007(99)00145-8; Salti IS, 1997, E MEDITERR HLTH J, V3, P462; SATMAN I, 2002, DIABETES CARE, V825, P1551; Scott TG, 1981, KING ABDULAZIZ MED J, V1, P23; Southwell A, 1997, PRACTICAL DIABETES I, V14, P201, DOI 10.1002-pdi.1960140710; Uysal AR, 1998, DIABETES CARE, V21, P2033, DOI 10.2337-diacare.21.11.2033; Yarahmadi Sh, 2003, J Coll Physicians Surg Pak, V13, P32914310210
Influence of Intermittent Fasting During Ramadan on Circadian Variation of Symptom-Onset and Prehospital Time Delay in Acute ST-Segment Elevation Myocardial Infarction
No full textRamadan interferes with circadian rhythms mainly by disturbing the routine patterns of feeding and smoking. The objective of this study was to investigate the circadian pattern of ST elevation acute myocardial infarction (STEMI) during the month of Ramadan. We studied consecutive STEMI patients 1 month before and after Ramadan (non-Ramadan group-NRG) and during Ramadan (Ramadan group-RG). The RG group was also divided into two groups, based on whether they chose to fast: fasting (FG) and non-fasting group (NFG). The time of STEMI onset was compared. A total of 742 consecutive STEMI patients were classified into 4 groups by 6 h intervals according to time-of-day at symptom onset. No consistent circadian variation in the onset of STEMI was observed both between the RG (P =.938) and NRG (P =.766) or between the FG (P =.232) and NFG (P =.523). When analyzed for subgroups of the study sample, neither smoking nor diabetes showed circadian rhythm. There was a trend towards a delay from symptom onset to hospital presentation, particularly at evening hours in the RG compared with the control group. In conclusion, there was no significant difference in STEMI onset time, but the time from symptom onset to hospital admission was significantly delayed during Ramadan. © The Author(s) 2022
Frequency-tunable and pattern diversity antennas for cognitive radio applications
No full textFrequency-tunable microstrip antennas, for cognitive radio applications, are proposed herein. The approach is based on tuning the operating frequency of a bandpass filter that is incorporated into a wideband antenna. The integration of an open loop resonator- (OLR-) based adjustable bandpass filter into a wideband antenna to transform it into a tunable filter-antenna is presented. The same technique is employed to design a cognitive radio pattern diversity tunable filter-antenna. A good agreement between the simulated and measured results for the fabricated prototypes is obtained. The radiation characteristics of each designed tunable filter-antenna are included herein. © 2014 A. H. Ramadan et al.Acampora A., 2010, P IEEE INT MICR WORK, P1; Al-Husseini M, 2011, IEEE ANTENNAS PROP, P2212; [Anonymous], SMV1405 SMV1419 HYP; Carey-Smith B. E., 2005, EURASIP Journal on Wireless Communications and Networking, V2005, DOI 10.1155-WCN.2005.354; Hong JS, 1997, IEEE T MICROW THEORY, V45, P2358; Lourandakis E, 2012, IEEE MICROW MAG, V13, P111, DOI 10.1109-MMM.2011.2173987; Marques R, 2008, WILEY MICRO, P1; Perruisseau-Carrier J., 2010, P R SOC B, P1; Razavi B, 2009, IEEE CUST INTEGR CIR, P391; Yucek T, 2009, IEEE COMMUN SURV TUT, V11, P116, DOI 10.1109-SURV.2009.0901091
Effects of Ramadan and non-Ramadan intermittent fasting on body composition: a systematic review and meta-analysis
No full textCopyright © 2021 Correia, Santos, Pezarat-Correia, Silva and Mendonca. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Intermittent fasting (IF) has gained popularity for body-composition improvement purposes. The aim of this systematic review and meta-analysis was to summarize the effects of Ramadan vs. non-Ramadan IF on parameters of body composition. We conducted a comprehensive search of peer-reviewed articles in three electronic databases: PubMed, Scopus, and Web of Science (published until May 2020). Studies were selected if they included samples of adults (≥18 years), had an experimental or observational design, investigated any type of IF and included body composition outcomes. Meta-analytical procedures were conducted when feasible. Sixty-six articles met the eligibility criteria. We found that non-Ramadan IF is effective for decreasing body weight (-0.341 (95% CI [-0.584, -0.098], p = 0.006), body mass index (-0.699, 95% CI [-1.05, -0.347], p 0.05). Conversely, we observed a significant increase in fat-free mass when comparing pre- to post-intervention in a within design fashion (0.306, 95% CI [0.133, 0.48], p = 0.001). Finally, despite being accompanied by dehydration, Ramadan IF is effective in decreasing body weight (-0.353; 95% CI [-0.651, -0.054], p = 0.02) and relative fat mass (-0.533; 95% CI [-1.025, -0.04], p = 0.034). Ramadan IF seems to implicate some beneficial adaptations in weight management, although non-Ramadan IF appears to be more effective in improving overall body composition.This work was partly supported by the Fundação para a Ciência e Tecnologia, under Grant UIDB/00447/2020 to CIPER—Centro Interdisciplinar para o Estudo da Performance Humana (unit 447) and by Universidade de Lisboa (grant attributed to JC-n C00246e).info:eu-repo/semantics/publishedVersio
Insulin therapy during Ramadan fast for Type 1 diabetes patients
No full textPatients with Type 1 diabetes (T1D) are normally exempt from the Ramadan fast; however, some patients insist on following the fast, often without the approval of their physicians. The aim of this study is to provide patients with T1D, who insist on fasting, with the most appropriate insulin regimen during the month of Ramadan. Seventeen patients with T1D who insisted on fasting were studied. Prior to Ramadan, the intermediate insulin was changed to ultralente in all patients. The total dose of insulin given to fasting patients by the end of Ramadan (45.7±14.4 U-day) was less than the total dose of insulin given before fasting (52.8±13.1 U-day) p0.05. The ultralente and regular insulin constituted 70 and 30percent, respectively, of the total insulin dose by the end of Ramadan, divided equally between Suhur (before sunrise) and Iftar (after sunset). There was no change in the glycosylated hemoglobin before and after fasting. Patients were instructed to break their fast after any episode of hypoglycemia. There were no severe daytime hypoglycemia episodes. We recommend that patients with T1D wishing to fast be switched to long acting insulin such as ultralente. The total insulin dose should consist of around 85percent of their initial insulin dose and it should be composed of around 70percent ultralente and 30percent rapid insulin, divided equally between Suhur and Iftar. ©2005, Editrice Kurtis.ALNAKHI A, 2 INT C HLTH RAM 199, P77; Mafauzy M, 1990, Med J Malaysia, V45, P14; BELKHADIR J, 1993, BRIT MED J, V307, P292; BOUGUERRA R, 1997, 2 INT C HLTH RAM DEC; Dehghan M., 1994, J FM SBUMS, V18, P42; Friedrich I., 2000, Harefuah, V138, P19; HALLAK MH, 1988, AM J CLIN NUTR, V48, P1197; Kadiri A, 2001, DIABETES METAB, V27, P482; LAAJAM MA, 1990, E AFR MED J, V67, P732; MAFAUZY M, 1990, MED J MALAYSIA, V5, P14; RASHED AH, 1992, BRIT MED J, V304, P521; SALMAN H, 1992, DIABETIC MED, V9, P583; SULIMANI RA, 1988, DIABETIC MED, V5, P589; SULIMANI RA, 1991, NUTR RES, V11, P261, DOI 10.1016-S0271-5317(05)80126-5; Uysal A, 1997, 2 INT C HLTH RAM DEC, P4416131
Efficacy and safety of insulin glargine and glimepiride in subjects with Type 2 diabetes before, during and after the period of fasting in Ramadan
No full textAims To determine the safety and efficacy of insulin glargine and glimepiride in patients with Type 2 diabetes before and after Ramadan and during fasting for Ramadan. Methods In this open, descriptive, multi-centre, prospective study, insulin-naïve (n = 100) or previously insulin-treated (n = 249) patients with Type 2 diabetes received insulin glargine [titrated from 10 U daily according to fasting blood glucose (FBG)] and glimepiride (4 mg daily). The number and type of hypoglycaemic episodes and glycaemic control were assessed before, during and after Ramadan. Bivariate logistic regression analyses were used to identify factors which predicted hypoglycaemia during Ramadan. Results Only one episode of severe hypoglycaemia occurred in each time period before, during and after Ramadan. Mild hypoglycaemic episodes increased from 156 pre-Ramadan to 346 during Ramadan (P 0.001) and decreased to 153 post-Ramadan (P = 0.0002).The increase during Ramadan was mainly attributed to increased symptomatic hypoglycaemic episodes. FBG and glycated haemoglobin improved during the titration period and did not change during the rest of the study. Risk of hypoglycaemic events during Ramadan was higher in countries where fasting is strict [odds ratio (OR) 3.69 (2.06-6.63), P 0.0001]. Lower weight [ 70.0 kg; OR 2.56 (1.46-4.48), P = 0.001] and waist circumference [ 90 cm; OR 3.06 (1.62-5.78), P = 0.001] increased the risk of hypoglycaemia during Ramadan whilst FBG 6.7 mmol-l [OR 0.3 (0.17-0.54), P 0.0001] had a protective effect. Conclusions Combination of insulin glargine and glimepiride may be used during Ramadan in patients with Type 2 diabetes who wish to fast, provided glimepiride is given at the time of breaking the fast and insulin glargine titrated to provide FBG 6.7 mmol-l. © 2009 Diabetes UK.Akram J, 1999, DIABETIC MED, V16, P861; Al-Arouj M, 2005, DIABETES CARE, V28, P2305, DOI 10.2337-diacare.28.9.2305; Mafauzy M, 1990, Med J Malaysia, V45, P14; Anwar A, 2006, Med J Malaysia, V61, P28; Bolli GB, 2002, INT J CLIN PRACT, P65; Cesur M, 2007, DIABETES RES CLIN PR, V75, P141, DOI 10.1016-j.diabres.2006.05.012; Chandalia HB, 1987, PRACTICAL DIABETES, V4, P287, DOI 10.1002-pdi.1960040610; Duckworth W, 2009, NEW ENGL J MED, V360, P129, DOI 10.1056-NEJMoa0808431; Gerstein HC, 2008, NEW ENGL J MED, V358, P2545; ISMAIL MMA, 2003, DIABETES RES CLIN PR, V50, P71; Kadiri A, 2001, DIABETES METAB, V27, P482; Kassem HS, 2005, J ENDOCRINOL INVEST, V28, P802; Kodiri A, 1998, PRACT DIABET S1, V15, pS5, DOI DOI 10.1002-PDI.1960150906; LAAJAM MA, 1990, E AFR MED J, V67, P732; Mafauzy M, 2002, DIABETES RES CLIN PR, V58, P45, DOI 10.1016-S0168-8227(02)00104-3; Mattoo V, 2003, DIABETES RES CLIN PR, V59, P137, DOI 10.1016-S0168-8227(02)00202-4; Mucha GT, 2004, DIABETES CARE, V27, P1209, DOI 10.2337-diacare.27.5.1209; Riddle MC, 2003, DIABETES CARE, V26, P3080, DOI 10.2337-diacare.26.11.3080; Salti I, 2004, DIABETES CARE, V27, P2306, DOI 10.2337-diacare.27.10.2306; Skyler JS, 2009, CIRCULATION, V119, P351, DOI 10.1161-CIRCULATIONAHA.108.191305; Uysal AR, 1998, DIABETES CARE, V21, P2033, DOI 10.2337-diacare.21.11.2033; Wild S, 2004, DIABETES CARE, V27, P1047, DOI 10.2337-diacare.27.5.104724
Suggested insulin regimens for patients with type 1 diabetes mellitus who wish to fast during the month of Ramadan
No full textObjectives:This paper reviews available information on insulin regimens that may enable patients with type 1 diabetes mellitus to fast during the month of Ramadan with minimal complications. It also provides guidance for health care professionals in managing patients who wish to observe the fast. Methods:Relevant English-language articles were identified through searches of the MEDLINE, EMBASE, and Index Medicus Eastern Mediterranean Region databases (all, 1980-2008) conducted in February 2008 using the terms Ramadan, fasting, type 1 diabetes mellitus, hypoglycemia, and hypotension. Only original research and review articles related to adult patients with type 1 diabetes were considered for review, excluding pregnant women and patients with poorly controlled disease. Results:The literature review identified 5 clinical trials relevant to type 1 diabetes and fasting. Two main meals are eaten during Ramadan, one before dawn (Suhur) and the other at sunset (Iftar). Suggested adjustments to the insulin regimen during fasting include using 70percent of the pre-Ramadan dose, divided as follows: 60percent as insulin glargine given in the evening and 40percent as an ultra-short-acting insulin (insulin aspart or lispro) given in 2 doses, 1 at Suhur and 1 at Iftar. Alternatively, 85percent of the pre-Ramadan dose may be divided as 70percent Ultralente and 30percent regular insulin, both given in 2 doses, 1 at Suhur and 1 at Iftar. Another option is to give 100percent of the pre-Ramadan morning dose of 70-330 premixed insulin at Iftar and 50percent of the usual evening dose at Suhur. Patients who observe the fast should be advised to monitor their blood glucose regularly,avoid skipping meals or overeating,and maintain contact with their physician throughout the fast. The fast should be broken immediately if blood glucose drops below 60 mg-dL (3.3 mmol-L).Breaking the fast should be considered when blood glucose drops below 80 mg-dL (4.4 mmol-L), and the fast should be interrupted if blood glucose rises above 300 mg-dL (16.7 mmol-L) to avoid diabetic ketoacidosis. Fasting is contraindicated in patients with poorly controlled type 1 diabetes,including those with a history of severe hypoglycemia and- or diabetic ketoacidosis at least 3 months before Ramadan; those with comorbid conditions (eg, unstable angina, uncontrolled hypertension, advanced macrovascular complications, infections, renal insufficiency);; those who are noncompliant with diet and medication; those who engage in intense physical activity; pregnant women; and the elderly. Conclusion:Patients with type 1 diabetes who wish to fast during Ramadan should follow specific recommendations and be closely monitored by their physician. © 2008 Excerpta Medica Inc. All rights reserved.Al-Arouj M, 2005, DIABETES CARE, V28, P2305, DOI 10.2337-diacare.28.9.2305; ALNAKHNI A, 1997, DIABETOLOGIA, V1297, pA330; Mafauzy M, 1990, Med J Malaysia, V45, P14; Azizi F, 2003, ARCH IRAN MED, V6, P237; Benaji B, 2006, DIABETES RES CLIN PR, V73, P117, DOI 10.1016-j.diabres.2005.10.028; BOLLI GB, 1984, NEW ENGL J MED, V310, P1706, DOI 10.1056-NEJM198406283102605; Boyle PJ, 2007, SOUTH MED J, V100, P175; Carr ME, 2001, J DIABETES COMPLICAT, V15, P44, DOI 10.1016-S1056-8727(00)00132-X; Cryer PE, 2005, DIABETES, V54, P3592, DOI 10.2337-diabetes.54.12.3592; *FRSMR, 1995, INT M DIAB RAM REC E; KADIRI A, 2005, PRACT DIABET INT, V15, pS5; Kadiri A, 2001, DIABETES METAB, V27, P482; Kassem HS, 2005, J ENDOCRINOL INVEST, V28, P802; KHAIRALLAH W, 2008, LMJ, V56, P46; Laederach-Hofmann K, 1999, AM J MED, V106, P50, DOI 10.1016-S0002-9343(98)00367-2; Laing SP, 1999, DIABETIC MED, V16, P466, DOI 10.1046-j.1464-5491.1999.00076.x; Mucha GT, 2004, DIABETES CARE, V27, P1209, DOI 10.2337-diacare.27.5.1209; Omar MAK, 1997, DIABETES CARE, V20, P1925; Pinar Rukiye, 2002, Br J Nurs, V11, P1300; RASHED AH, 1992, BRIT MED J, V304, P521; Reiter J, 2007, DIABETIC MED, V24, P436, DOI 10.1111-j.1464-5491.2007.02098.x; Salti I, 2004, DIABETES CARE, V27, P2306, DOI 10.2337-diacare.27.10.2306; SULIMANI RA, 1988, DIABETIC MED, V5, P58921131
Safety and Tolerability of Sodium Glucose Co-transporter -2 Inhibitors (SGLT2i) During Ramadan Fasting
No full textBackground: Diabetic management during Ramadan fasting is a significant clinical challenge. Sodium glucose co-transporter -2 inhibitors (SGLT2i) are new class of antidiabetic medications known for low frequency of associated hypoglycemia. The present study aimed to evaluate efficacy, safety and tolerability of SGLT2i in diabetic patients practicing Ramadan fasting. Patients and methods: The study included 94 patients. They comprised 51 patients who received metformin and sulfonylureas (SU): glimepiride (1-6 mg/d) or gliclazide MR (60-120mg/d) and 43 patients who received metformin and SGLT2i: empagliflozin (25 mg), dapagliflozin (10 mg) or canagliflozin (300 mg). The study outcome parameters were frequency of hypoglycemia episodes, volume depletion episodes, number of days with early breaking of fasting and missed fasting days. Results: It was found that patients in SGLTi group experiences significantly fewer symptomatic (9.3 % versus 35.3 %, p=0.003) and documented (7.0 % versus 25.5 %, p=0.017) hypoglycemic episodes as compared to the SU group. However, there were no significant differences between the studied groups regarding the frequency of patients with volume depletion episodes (5.9 % versus 16.3 %, p= 0.1). Moreover, there were no significant differences between groups regarding the frequency of patients with early breaking of fasting (11.8 % versus 9.3 %, p=0.7) or missed fasting (3.9 % versus 2.3 %, p=0.66). None of the studied patients discontinued the prescribed medications. Conclusions: SGLT2i combined with metformin for diabetic patients during Ramadan fasting are effective, safe and well-tolerated with the advantage of reduced hypoglycemic events
A methodology for scheduling overlapped design activities based on dependency information
No full textThe practice of overlapping activities is becoming a requirement for fast-tracking complex construction projects. The amount, timing, and nature of the information exchanged between pairs of activities determine the degree to which pairs of activities may be overlapped. This paper presents a four-step process for scheduling the design phase of fast-tracked construction projects while taking into consideration information exchange among project activities. The process starts with capturing and quantifying this exchange of dependency information. A contemporary scheduling tool, the dependency structure matrix (DSM), aids in generating the shortest (overlapped) schedule based on dependencies among the different design disciplines. An algorithm is designed to calculate the shortest possible schedule for the design phase of a construction project. The developed scheduling algorithm is unique as it includes information exchange alongside task durations. The algorithm is validated in the context of a real-world case study, a fast-tracked multi-billion dollar educational facility project in the Arabian Peninsula. © 2012 Elsevier B.V. All rights reserved.AITSAHLIA F, 1995, IEEE T ENG MANAGE, V42, P166, DOI 10.1109-17.387269; Attar A., 2009, ENG CONSTRUCTION ARC, V6, P376; Austin S., 2000, CONSTRUCTION MANAGEM, V18, P173, DOI DOI 10.1080-014461900370807; Baldwin A. N., 1998, Automation in Construction, V8, DOI 10.1016-S0926-5805(98)00059-4; Blackburn J. D., 1991, TIME BASED COMPETITI; Blacud NA, 2009, J CONSTR ENG M ASCE, V135, P199, DOI 10.1061-(ASCE)0733-9364(2009)135:3(199); Bogus S.M., 2006, CONSTR MANAGE EC, V24, P829, DOI 10.1080-01446190600658529; Browning TR, 2002, IEEE T ENG MANAGE, V49, P428, DOI 10.1109-TEM.2002.806709; Browning TR, 2001, IEEE T ENG MANAGE, V48, P292, DOI 10.1109-17.946528; Choo HJ, 2004, AUTOMAT CONSTR, V13, P313, DOI 10.1016-j.autcon.2003.09.012; van Marrewijk Alfons, 2008, International Journal of Project Management, V26, DOI 10.1016-j.ijproman.2007.09.007; Clough R.H., 1991, CONSTRUCTION PROJECT; DELAGARZA JM, 1994, J MANAGE ENG, V10, P46, DOI 10.1061-(ASCE)9742-597X(1994)10:3(46); Eldin NN, 1997, J CONSTR ENG M ASCE, V123, P354, DOI 10.1061-(ASCE)0733-9364(1997)123:3(354); EPPINGER SD, 1994, RES ENG DES, V6, P1, DOI 10.1007-BF01588087; Ford DN, 2003, CONCURRENT ENG-RES A, V11, P177, DOI 10.1177-106329303038031; Hegazy T, 2004, J CONSTR ENG M ASCE, V130, P160, DOI 10.1061-(ASCE)0733-9364(2004)130:2(160); Hegazy T, 2011, AUTOMAT CONSTR, V20, P1051, DOI 10.1016-j.autcon.2011.04.006; Ibbs C. W., 1998, PROJECT MANAGEMENT J, V29, P35; Jaafari A, 1997, J CONSTR ENG M ASCE, V123, P427, DOI 10.1061-(ASCE)0733-9364(1997)123:4(427); Jeevan J., 2011, P 13 INT DEP STRUCT, P263; Koo B., 2003, 75 CIFE STANF U; Krishnan V, 1997, MANAGE SCI, V43, P437, DOI 10.1287-mnsc.43.4.437; Levitt RE, 1999, MANAGE SCI, V45, P1479, DOI 10.1287-mnsc.45.11.1479; Loch CH, 2005, PROD OPER MANAG, V14, P331; Maheswari J. U., 2005, International Journal of Project Management, V23, DOI 10.1016-j.ijproman.2004.10.001; Maheswari JU, 2006, J CONSTR ENG M ASCE, V132, P482, DOI 10.1061-(ASCE)0733-9364(2006)132:5(482); Martinez J. C., 2001, Proceeding of the 2001 Winter Simulation Conference (Cat. No.01CH37304), DOI 10.1109-WSC.2001.977485; Pena-Mora F, 2001, J CONSTR ENG M ASCE, V127, P1; Prasad B., 1996, CONCURRENT ENG FUNDA; Senthilkumar Venkatachalam, 2009, Architectural Engineering and Design Management, V5, DOI 10.3763-aedm.2009.0103; Senthilkumar V, 2010, AUTOMAT CONSTR, V19, P197, DOI 10.1016-j.autcon.2009.10.007; Shang H. P., 2005, ENG CONSTRUCTION ARC, V12, P391, DOI 10.1108-09699980510608839; Sharman DM, 2007, CONCURRENT ENG-RES A, V15, P157, DOI 10.1177-1063293X07079320; Smith RP, 1997, IEEE T ENG MANAGE, V44, P67, DOI 10.1109-17.552809; Srour I.M., 2011, P MOD METH ADV STRUC, pS1; Steward D.V., 1965, SIAM J NUMER ANAL, V2, P345; Tang D., 2009, ADV ENG INFORM, V24, P159; Terwiesch C, 1999, MANAGE SCI, V45, P455, DOI 10.1287-mnsc.45.4.455; Wang C.W., 2006, AUTOMAT CONSTR, V15, P589; WILLIAMS GV, 1995, J MANAGE ENG, V11, P24, DOI 10.1061-(ASCE)0742-597X(1995)11:5(24); Yassine A, 2003, CONCURRENT ENG-RES A, V11, P165, DOI 10.1177-106329303034503; Yassine A, 1999, INT J PROD RES, V37, P2957, DOI 10.1080-002075499190374; Yassine A.A., 2004, QUADERNI MANAGEMENT, P9; Zhao ZY, 2010, J CONSTR ENG M ASCE, V136, P659, DOI 10.1061-(ASCE)CO.1943-7862.000016833
Adjusting the basal insulin regimen of patients with type 1 diabetes mellitus receiving insulin pump therapy during the Ramadan fast: A case series in adolescents and adults
No full textBackground: Ramadan, the ninth month of the Islamic lunar calendar, is the holy month of fasting for adolescent and adult Muslims. Observance of Ramadan is considered obligatory for every healthy adult Muslim. During this time, Muslims refrain from eating, drinking, smoking, and administering oral or parenteral medications from sunrise to sunset daily for 28 to 30 days. Case summary: We evaluated the need for changes in basal insulin regimen in 5 patients (4 males and 1 female; age range, 15-19 years) with type 1 diabetes mellitus (T1DM) who fasted during Ramadan. The patients were receiving insulin pump therapy with regular human insulin and maintained weekly visits with their endocrinologist at The Chronic Care Center (Beirut, Lebanon). They were instructed to break the fast after any episode of hypoglycemia (finger stick glucose 70 mg-dL) or severe hyperglycemia (finger stick glucose ≥300 mg-dL or any hyperglycemia associated with presence of urine ketone bodies on urinary dipstick). Blood glucose concentrations did not change significantly with fasting. Finger stick blood glucose taken at 4-hour intervals decreased in the afternoon (at 4 pm) and increased in the evening and morning (10 pm and 8 am, respectively) during this month in 4 of 5 patients, while no significant change in circadian rhythm of finger stick blood glucose was observed in 1 patient. Based on the investigators' findings, the basal insulin requirement decreased by 5.5percent to 25.0percent (4 patients) or did not change (1 patient) during the fast. Changes in regimens, based on collaboration between the endocrinologist and diabetes educational nurse, were determined by blood glucose self-monitoring done at 4-hour intervals during the fasting period, pre-Suhur (predawn breakfast), and ≥2 hours after Iftar (evening fast-breaking meal). No cases of keto-acidosis or severe hypoglycemia were reported. Conclusion: These 5 adolescent and adult patients with T1DM who were using an insulin pump were able to fast during Ramadan without incidences of severe hypoglycemia or ketoacidosis by using close blood glucose self-monitoring and weekly follow-up with their endocrine team, which consisted of an endocrinologist, a registered nutritionist, and a diabetes educational nurse. © 2009 Excerpta Medica Inc. All rights reserved.Al-Arouj M, 2005, DIABETES CARE, V28, P2305, DOI 10.2337-diacare.28.9.2305; Azar Sami T, 2008, J Med Liban, V56, P46; Azizi F, 1998, INT J RAMADAN FASTIN, V2, P8; Benaji B, 2006, DIABETES RES CLIN PR, V73, P117, DOI 10.1016-j.diabres.2005.10.028; Friedrich I., 2000, Harefuah, V138, P19; Kadiri A, 2001, DIABETES METAB, V27, P482; Kassem HS, 2005, J ENDOCRINOL INVEST, V28, P802; Pinar Rukiye, 2002, Br J Nurs, V11, P1300; RASHED AH, 1992, BRIT MED J, V304, P521; Salti I, 2004, DIABETES CARE, V27, P2306, DOI 10.2337-diacare.27.10.230612
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