The association between Ramadan, pre-Ramadan diabetes education (PRE) and metabolic parameters in people with type 2 diabetes: A longitudinal study using routine primary care data

Aims: To assess the impact of Ramadan and pre-Ramadan diabetes education (PRE) on metabolic parameters in people with type 2 diabetes (T2D). Additionally, we described the proportion of Ramadan-related adverse events. Methods: A retrospective longitudinal study utilising Dutch routine primary care data from 133 people with T2D who participated in a PRE session. Linear Generalized Estimating Equations models were used to assess the association of metabolic parameters with Ramadan and PRE. We analysed free-text notes and a questionnaire to identify Ramadan-related adverse events. Results: Ramadan was associated with modest reductions in HbA1c (β −1.07 mmol/mol; p = 0.07), systolic blood pressure (β −1.89 mmHg; p = 0.04), weight (β −0.81 kg; p < 0.01), BMI (β −0.29 kg/m²; p < 0.01), and a slight increase in triglycerides (β 0.27 mmol/l; p = 0.04) compared to non-Ramadan periods. PRE demonstrated no significant impact on metabolic parameters. The number of medical notes regarding Ramadan was small, with the mentioning of some physical complaints and medication errors. Conclusions: In our study, Ramadan is associated with temporary and marginal metabolic improvements in people with T2D. A single PRE session had no substantial impact on metabolic control. Healthcare professionals should more often discuss Ramadan and medication adjustments with their patients.