OBJECTIVES: The DAR Global survey of Ramadan-fasting during the COVID-19 pandemic aimed to describe the characteristics and care in participants with type 2 diabetes (T2D) with a specific comparison between those <65 years and & #8805; 65 years .
METHODS: Participants were consented to answer a physician-administered questionnaire following Ramadan 2020 . Impact of COVID-19 on the decision of fasting, intentions to fast and duration of Ramadan and Shawal fasting, hypoglycaemia and hyperglycaemia events were assessed . Specific analysis comparing age categories of <65 years and & #8805; 65 years were performed .
RESULTS: Among the 5865 participants , 22.5% were & #8805; 65 years old . Concern for COVID-19 affected fasting decision for 7.6% (& #8805; 65 years) vs 5.4% (< 65 years). More participants & #8805; 65 years old did not fast (28.8% vs 12.7%, <65 years). Of the 83.6%, participants fulfilling Ramadan-fasting , 94.8% fasted & #8805; 15 days and 12.6% had to break fast due to diabetes-related illness . The average number of days fasting within and post-Ramadan were 27 and 6 days respectively, regardless of age . Hypoglycaemia and hyperglycaemia occurred in 15.7% and 16.3% of participants respectively, with 6.5% and 7.4% requiring hospital care respectively . SMBG was performed in 73.8% of participants and 43.5% received Ramadan-focused education .
CONCLUSION: During the COVID-19 pandemic, universally high rates of Ramadan-fasting were observed regardless of fasting risk level . Glycemic complications occurred frequently with older adults requiring higher rates of acute hospital care . Risk stratification is essential followed by pre-Ramadan interventions, Ramadan-focused diabetes education and self-monitoring to reduce and prevent complications, with particular emphasis in older adults.