The proportion of diabetic ketoacidosis emergencies during Ramadan fasting: a retrospective study

Ramadan fasting is an annual religious event in the Muslim calendar that has been shown to affect diabetes control. The relationship between Ramadan fasting and increased diabetic ketoacidosis (DKA) presentations was studied in several settings, but results are still mixed. Our study aims to address this knowledge gap and estimate the frequency and correlates of DKA emergencies during the month of Ramadan using a more informative study design with repeated observations over three months during the 3-year study period.

This was a retrospective, medical record-based observational 3-year study with repeated observations over the 3-month period of pre-Ramadan, Ramadan, and post-Ramadan.

This study included a total of 125 patients with an established diagnosis of DKA who presented to the hospital during the 3-year study period. Of these, 56 (44.8%) patients were diagnosed with DKA during Ramadan, far in excess of the number diagnosed during the other months, by a 1.75 ratio for Sha'aban and a 1.51 ratio for Shawwal. The severity of DKA presentations was far less during Ramadan than during the other months (odds reduced by 47.4%, p = 0.01803). In addition, older age was associated with a more severe presentation (odds increased by 4.7% for each additional year of age, p = 0.00885).

Consistent with the literature, we found that severe DKA presentations during Ramadan were more likely to occur in older adults. We also found that when DKA was diagnosed during Ramadan, it was less likely to be severe than presentations during both the Sha'aban and Shawwal months combined. This, we theorize, may be explained by the higher carbohydrate dietary content during Iftar (breakfast) and Sahoor (pre-fasting meal). This is not a well-established fact, however, and should await studies that focus on the association between nutritional intake during these special times and the severity of DKA presentations.