FASTING AND DIABETES MEDICATIONS: OPTIMISING HEALTH OUTCOMES FOR RAMADAN OBSERVERS

Abstract

Background and Objectives: Diabetes is increasingly becoming a common disease among Australians. Religious practices such as Ramadan fast (a stringent fast requiring total abstinence from food and drink between sunrise and sunset during the 9th month of the Islamic lunar calendar by Muslims) can impact on established glycaemic and lipid control or medication regimens, with a risk of adverse consequences for the observers. Community pharmacists are in a unique venue and have opportunity to enhance health outcomes for those with diabetes observing Ramadan. This study investigated the perspective of patients with diabetes who fast during Ramadan to understand their experiences, health related needs and service preferences. It also explored the perspectives, experiences and suggestions of community pharmacists in providing specialised medication and health services to such patients in Sydney, Australia. Methods: Qualitative, semi-structured face-to-face interviews were conducted between June and August 2015 with a purposive convenient sample of patients (n=25) with Type 2 diabetes (T2D) and community pharmacists (n=21) practising in ethnically diverse areas of Sydney, using a standardised interview guide. The data obtained was translated (from Arabic to English only in the case of most patients’ interviews), verified, coded and thematically analysed in a grounded theory approach. Results and Conclusions: Thematic diversity was observed in issues of prioritisation or religion over health, adherence to socio-cultural norms, issues in health care access and a strongly expressed need for community information services. Awareness about potential roles community pharmacists could enact was rather limited. These themes suggested that community awareness about the role of the pharmacists in assisting medication use and adjustment during fasting periods should be enhanced. Further, community pharmacists need to be trained about the unique religious and socio-cultural issues of patients with diabetes opting to observe spiritual rituals such as fasts. Clinical education in this area should up-skill pharmacists to inculcate self-management behaviours in fasting T2D patients. Pharmacists encounter patients with chronic conditions who observe religious fasts that may interrupt established medication regimens. Proactive counselling about medication use in these instances is offered only by some pharmacists. Professional awareness of the effect of religious practices is important and protocols to assist patients in these situations should be developed and disseminated. Standardised service provision is likely to facilitate positive patient expectations so that pharmacies and pharmacists are viewed as a normal channel for seeking help by fasting patients.