The Association between Health-Related Quality of Life and Ramadan Fasting in Diabetic Patients: A Survey Using A Structured D-39 Assessment Tool. A Sudanese Cohort

Authors

1 Ministry of health - Sudan

2 Dubai Hospital, Dubai Health Authority

Abstract

Introduction: Most cases of chronic diseases result in physical, psychological, financial, and social burdens on the patients and the economy. The overall health-related quality of life of patients can be positively influenced by several variables including glycemic control, economic status, comorbidities, presence of complications, and the quality of medical, psychological, and social support. Studies examining the effects of fasting on diabetes during Ramadan fasting underline the biochemical changes without considering the psychosocial and financial implications. This study aimed to illuminate some of the challenges faced by both fasting and non-fasting diabetic patients during Ramadan.Further, we evaluated the quality of life of diabetes patients, explored the socio-demographic and disease-related variables, and estimated the percentage of diabetic patients who fasted during Ramadan. Methods: This was a community-based cross-sectional study conducted from August 2015 to October 2015. Diabetes 39 instrument was administered to 112 patients with diabetes in Khartoum to evaluate their health-related quality of life during Ramadan. Results: Fifty-four percent of study participants were female and 64.3% of them were aged between 40-60 years old. Sixty-two participants were able to fast (55.4%) and fasted for more than 15 days. Half of the participants had, at least, one comorbidity, among which hypertension was the most common. Approximately 59% of fasting patients had mild impairment in their health-related quality of life, whereas 60% of non-fasting participants had moderate impairment. Limited stamina, and fear of hypoglycemia were the items with the highest mean scores in both groups. The fasting group had a lower average score (2.88) compared to the non-fasting group (3.66). This difference was statistically significant (p=0.033). Conclusion: Over 53% of study patients fasted for at least 1 day during Ramadan. Interestingly, Patients who fasted had a better health-related quality of life when compared to those who did not fast. Patients with hypertension and cardiac diseases were the subjects least able to fast during Ramadan.

Keywords


  1. Media and events. International Diabetes Federation. Available at: URL: http://www.idf.org/media-events/press releases/2011/diabetes-atlas-5th-edition; 2016.
  2. Salti I, Bénard E, Detournay B, Bianchi-Biscay M, Le Brigand C, Voinet C, et al. 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. Diabetes Care. 2004; 27(10):2306-11.
  3. Suliman M, Abdu T, Elhadd T, Ibrahim S, Ahmed M, Malik R. Diabetes and fasting in Ramadan: Can we provide evidence-based advice to patients? Sudan Med J. 2010; 46(1):4-14.
  4. Elrayah-Eliadarous H. Economic burden of diabetes on patients and their families. California: Department of Public Health Sciences; 2007.
  5. Balla SA, Ahmed HA, Awadelkareem MA. Prevalence of diabetes, knowledge, and attitude of rural, population towards diabetes and hypoglycaemic event, Sudan 2013. Am J Health Res. 2014; 2(6):356-60.
  6. Montori VM. Evidence-based endocrinology. New York: Springer Science & Business Media; 2007. P. 187.
  7. Khanna A, Bush AL, Swint JM, Peskin MF, Street RL Jr, Naik AD. Hemoglobin A1c improvements and better diabetes-specific quality of life among participants completing diabetes self-management programs: a nested cohort study. Health Qual Life Outcomes. 2012; 10:48.
  8. Ballinger A. Essentials of Kumar & Clark’s Clinical Medicine. 5th ed. New York: Elsevier Health Sciences; 2012.
  9. Bani-Issa W. Evaluation of the health-related quality of life of Emirati people with diabetes: integration of sociodemographic and disease-related variables. East Mediterr Health J. 2011; 17(11):825-30.
  10. Weinberger M, Kirkman MS, Samsa GP, Cowper PA, Shortliffe EA, Simel DL, et al. The relationship between glycemic control and health-related quality of life in patients with non-insulin-dependent diabetes mellitus. Med Care. 1994; 32(12):1173-81.
  11. Pichon-Riviere A, Irazola V, Beratarrechea A, Alcaraz A, Carrara C. Quality of life in type 2 diabetes mellitus patients requiring insulin treatment in Buenos Aires, Argentina: a cross-sectional study. Int J Health Policy Manag. 2015; 4(7):475-80.
  12. Aghamollaei T, Eftekhar H, Shojaeizadeh D, Mohammad K, Nakhjavani M, Ghofrani Pour F. Behavior, metabolic control and health-related quality of life in diabetic patients at Bandar Abbas diabetic clinic. Iran J Public Health. 2003; 32(3):54-9.
  13. Abdelgadir M. Clinical and biochemical features of adult diabetes mellitus in Sudan. [Doctoral Dissertation]. Carolina: Acta Universitatis Upsaliensis; 2006.
  14. Hassan A, Meo SA, Usmani AM, Shaikh TJ. Diabetes during Ramadan–PRE-approach model: presentation, risk stratification, education. Eur Rev Med Pharmacol Sci. 2014; 18(12):1798-805.
  15. Zulian LR, Santos MA, Veras VS, Rodrigues FF, Arrelias CC, Zanetti ML. Quality of life in patients with diabetes using the Diabetes 39 (D-39) instrument. Revista Gaucha Enfermag. 2013; 34(3):138-46.
  16. Patel NR, Kennedy A, Blickem C, Rogers A, Reeves D, Chew-Graham C. Having diabetes and having to fast: a qualitative study of British Muslims with diabetes. Health Expect. 2015; 18(5):1698-708.
  17. Elbagir MN, Etayeb NO, Eltom MA, Mahadi EO, Wikblad K, Berne C. Health-related quality of life in insulin-treated diabetic patients in the Sudan. Diabetes Res Clin Pract. 1999; 46(1):65-73.
  18. Awadalla AW, Ohaeri JU, Tawfiq AM, Al-Awadi SA. Subjective quality of life of outpatients with diabetes: comparison with family caregivers’ impressions and control group. J Natl Med Assoc. 2006; 98(5):737-45.
  19. Zulian LR, Santos MA, Veras VS, Rodrigues FF, Arrelias CC, Zanetti ML. Quality of life in patients with diabetes using the Diabetes 39 (D-39) instrument. Rev Gaúcha Enferm. 2013; 34(3):138-46.