Impact of Ramadan focused education program on hypoglycemic risk and metabolic control for patients with type 2 diabetes

Figures & data

Table 1 Baseline demographic and clinical characteristics in the intervention and control groups

Variable	Intervention (n=140)	Control (n=122)	Test value	P-value
	Mean ± SD N (%)	Mean ± SD N (%)
Age (years)
Mean ± SD	55.12±12.76	56.06±11.08	t=0.630	0.530
<50	42 (30.0)	30 (24.6)	χ^2=4.675	0.097
50–59	52 (37.1)	36 (29.5)
≥60	46 (32.9)	56 (45.9)
Sex
Male	56 (40.0)	41 (33.6)	χ^2=1.143	0.285
Female	84 (60.0)	81 (66.4)
Residence
Riyadh	120 (85.7)	114 (93.4)	χ^2=4.079	0.043*
Outside Riyadh	20 (14.3)	8 (6.6)
Job status
Unemployed	65 (46.4)	15 (12.3)	χ^2=35.809	<0.001*
Working	75 (53.6)	107 (87.7)
Body weight	84.16±18.04	81.01±17.71	t=1.395	0.164
BMI
Mean ± SD	32.93±6.70	32.71±7.14	t=0.250	0.803
Normal (<25)	15 (10.7)	11 (9.0)	χ^2=1.971	0.578
Overweight (25–29)	32 (22.9)	37 (30.3)
Obese (30–34)	40 (28.6)	31 (25.4)
Morbid obese (≥35)	50 (35.7)	40 (32.8)
BP
Hypertension (>130/80)	96 (68.6)	87 (71.3)	χ^2=0.232	0.630
Systolic BP	130.14±13.85	130.12±15.40	t=0.011	0.991
Diastolic BP	73.34±8.94	72.98±8.88	t=0.319	0.750
Diabetes and its management
Duration (years)	12.95±8.39	12.86±7.61	U=0.092	0.927
On oral medications	118 (84.3)	101 (82.8)	χ^2=0.107	0.744
On insulin	134 (95.7)	111 (91.0)	χ^2=2.404	0.121
Number of oral medications	0.97±0.55	0.88±0.47	U=1.479	0.140
Number of insulin types	1.71±0.57	1.14±0.55	U=8.307	<0.001*
Hypoglycemia score	14.21±8.50	14.01±5.10	t=0.234	0.815
Acute complications**	0 (0.0)	6 (4.9)	χ^2=7.047	0.008*
HbA1c	9.79±1.89	10.04±1.47	t=−1.196	0.233
Lipid profile
LDL cholesterol	2.41±0.91	2.53±0.86	t=−1.041	0.299
HDL cholesterol	1.14±0.30	1.14±0.30	t=−0.075	0.940
Total cholesterol	4.35±1.13	4.42±1.27	t=−0.475	0.635
Triglycerides	1.62±0.79	1.86±1.48	t=−1.665	0.097

Notes: χ², chi-square test; t, Student t-test; U, Mann–Whitney U-test.

** Complications that occurred in the previous Ramadan.

* Statistically significant difference at P<0.05.

Abbreviations: BMI, body mass index; BP, blood pressure; HDL, high-density lipoprotein; LDL, low-density lipoprotein; SD, standard deviation.

Table 2 Impact of Ramadan focused education program on clinical characteristics during the study phases in the intervention and control groups

Variable	Pre-Ramadan	During Ramadan	Post-Ramadan	Phase difference
	Mean ± SD	Mean ± SD	Mean ± SD	P-value
Body weight (kg)
Intervention	84.16±18.04	85.85±17.37	85.38±17.09	0.063
Control	81.01±17.71	81.30±17.48	80.21±17.13	0.434
Group difference	P=0.164	P=0.038^*	P=0.017^*
BMI
Intervention	32.93±6.70	33.74±6.46	33.49±6.52	0.296
Control	32.71±7.14	32.45^#±7.00	31.50^#±6.63	0.013
Group difference	P=0.803	P=0.126	P=0.016^*
Systolic BP
Intervention	130.14±13.85	130.87±15.57	130.52±15.71	0.876
Control	130.12±15.40	131.20±15.24	130.21±14.25	0.714
Group difference	P=0.991	P=0.865	P=0.869
Diastolic BP
Intervention	73.34±8.94	72.29±10.31	72.39±9.77	0.558
Control	72.98±8.88	73.30±9.30	72.98±8.78	0.925
Group difference	P=0.750	P=0.408	P=0.605
LDL cholesterol
Intervention	2.41^#±0.91	2.12^#,$±0.68	2.28^$±0.73	<0.001^*
Control	2.53±0.86	2.46±0.89	2.60±0.98	0.109
Group difference	P=0.299	P=0.001^*	P=0.003^*
HDL cholesterol
Intervention	1.14^#,$±0.30	1.19^#±0.31	1.23^$±0.38	0.001^*
Control	1.14^#,$±0.30	1.24^#,^±0.33	1.29^$,^±0.34	<0.001^*
Group difference	P=0.940	P=0.211	P=0.214
Total cholesterol
Intervention	4.35^#,$±1.13	4.00^#±0.91	4.08^$±1.06	<0.001^*
Control	4.42±1.27	4.26±1.18	4.32±1.23	0.319
Group difference	P=0.635	P=0.047^*	P=0.088
Triglycerides
Intervention	1.62^#±0.79	1.49^#±0.72	1.53±0.93	0.028^*
Control	1.86±1.48	1.68±0.87	1.75±0.90	0.260
Group difference	P=0.097	P=0.054	P=0.053
Number of oral medications
Intervention	0.97±0.55	0.99±0.57	0.98±0.57	0.874
Control	0.88±0.47	0.84±0.46	0.89±0.53	0.438
Group difference	P=0.140	P=0.023^*	P=0.212
Number of insulin types
Intervention	1.71±0.57	1.64±0.63	1.64±0.61	0.331
Control	1.14±0.55	1.07±0.53	1.11±0.52	0.063
Group difference	P<0.001^*	P<0.001^*	P<0.001^*

Note: Symbols (#, $, ^) indicate the statistical differences between the phases (^*P<0.05).

Abbreviations: BMI, body mass index; BP, blood pressure; HDL, high-density lipoprotein; LDL, low-density lipoprotein; SD, standard deviation.

Table 3 Impact of Ramadan focused education program on glycemic control and hypoglycemia score during the study phases in the intervention and control groups

Variable	Pre-Ramadan	During Ramadan	Post-Ramadan	Phase difference
	Mean ± SD N (%)	Mean ± SD N (%)	Mean ± SD N (%)	P-value
HbA1c
Intervention	9.79^#,$±1.89	8.26^#±1.54	8.52^$±1.61	<0.001^*
Control	10.04^#,$±1.47	9.54^#±1.38	9.59^$±1.79	<0.001^*
Group difference (repeated measure)	P=0.233	P≤0.001^*	P≤0.001^*
HbA1c <7
Intervention	12 (8.6)	34 (24.3)	27 (19.3)	0.002^*
Control	2 (1.6)	3 (2.5)	4 (3.3)	0.711
Group difference	P=0.013^*	P≤0.001^*	P≤0.001^*
Hypoglycemia score
Intervention	14.21^#,$±8.50	6.36^#±6.17	5.44^$±5.55	<0.001^*
Control	14.01^#±5.10	13.46^$±5.30	9.27^#,$±4.65	<0.001^*
Group difference	P=0.815	P≤0.001^*	P≤0.001^*
Hypoglycemia score <8
Intervention	35 (25.0)	95 (67.9)	103 (73.6)	<0.001^*
Control	10 (8.2)	15 (12.3)	41 (33.6)	<0.001^*
Group difference	P<0.001^*	P<0.001^*	P<0.001^*

Note: Symbols (#, $, ^) indicate the statistical differences between the phases (^*P<0.05).

Abbreviation: SD, standard deviation.

Figure 1 Post-Ramadan percent changes (compared with pre-Ramadan levels) of glycemic control and hypoglycemia score in the intervention and control groups.

Table 4 Multiple linear regression model to predict HbA1c and hypoglycemia score by the study groupsa

Variable	Unstandardized coefficients		Standardized coefficients	t-test	P-value	95% confidence interval for B
	B	Standard error				Lower	Upper
HbA1c (%)
Constant	−17.75	3.86		−4.602	<0.001	−25.35	−10.16
Intervention vs control group	−7.20	2.49	−0.18	−2.888	0.004	−12.11	−2.29
Hypoglycemia (points)
Constant	−12.15	1.74		6.977	<0.001	8.73	−15.57
Intervention vs control group	−3.16	0.50	−0.22	6.351	<0.001	2.19	−4.14
Age	0.08	0.02	0.14	−3.700	<0.001	0.13	0.04
Education	0.81	0.20	0.16	−4.114	<0.001	1.20	0.42

Notes: r-square =0.03.

a Adjusted for age, sex, education, residence, job, BMI.

Abbreviation: BMI, body mass index.