Community pharmacists’ knowledge of diabetes management during Ramadan in Egypt
Background Although Muslim diabetic patients may be aware of their religious exemption from fasting, many still fast and adjust their medication regimens accordingly. Pharmacists have a significant potential to identify and prevent harm from medication misuse in Ramadan. Objectives This study examines Egyptian pharmacists’ knowledge regarding management of diabetes during Ramadan. It also explores pharmacists’ willingness to attend a 1 day workshop on medication regimen adjustment during Ramadan. Setting Community pharmacies throughout Alexandria, Egypt. Methods A cross-sectional study using a pretested self-administered survey was conducted among a random sample of community pharmacists. The survey included three knowledge questions relevant to counseling diabetic patients during Ramadan. Questions covered the recommended timing and dosing for metformin and insulin as well as the safe blood glucose range required for diabetic patients to safely continue their fast. Using logistic regression, a model was estimated to predict pharmacists’ willingness to attend a workshop on the adjustment of medication regimens during Ramadan. Content analysis was used to analyze pharmacists’ answers to the question concerning what they would like the workshop to cover. Main outcome measure Pharmacists’ aggregate scores for all three diabetes management knowledge questions and pharmacists’ willingness to attend a workshop on the adjustment of medication regimens during Ramadan. Results Ninety three percent of the 298 approached pharmacists agreed to participate. Forty three pharmacists (15.9 %) did not know the correct answer to any question, 118(43.7 %) 24 answered one correctly, 86 (31.9 %) answered two correctly and only 23 (8.5 %) answered all 25 three correctly. Confidence in therapeutic knowledge regarding medication regimen 26 adjustment during Ramadan was not associated with the pharmacists’ knowledge of diabetes management during Ramadan. One hundred seventy five (63.6 %) pharmacists wanted to attend a workshop on adjusting medication regimens during Ramadan. This was significantly associated with pharmacists being Muslim (OR 3.52, CI 1.70–7.27) and of younger age (OR 30 = 0.98, CI 0.96–0.99978). Pharmacists offered specific content and communication process 31 suggestions for the workshop content. Conclusion This study identifies variability among community pharmacists’ knowledge of diabetes management during Ramadan. It also shows willingness among the majority of pharmacists to learn more about the topic
KeywordsDiabetes Egypt Fasting Guidelines Islam Medication Muslim patients Pharmacists Pharmacy Ramadan Religion
The authors would like to thank Dr. David Kreling, Dr. Nora Cate Schaeffer, Dr. Henry Young and Dr. Connie Kraus at the University of Wisconsin-Madison for their comments and suggestions which have been instrumental in shaping this project. The first author is thankful for the support received from the Joseph Wiederholt Wisconsin Distinguished Graduate Fellowship during the academic year 2012–2013.
This research was supported by a dissertator grant award provided by the Sonderegger Research Center at the School of Pharmacy, University of Wisconsin-Madison.
Conflicts of interest
The authors declare no conflict of interest.
- 2.Arafa N, Amin G. The epidemiology of diabetes mellitus in Egypt: Results of a National Survey. Egypt J Comm Med. 2010;28:29–43.Google Scholar
- 3.El-Zanaty F, Way A. Egypt demographic and health survey 2008. Cairo, Egypt: Ministry of Health, El-Zanaty and Associates, and Macro International; 2009.Google Scholar
- 13.Hassanein M, et al. Comparison of the dipeptidyl peptidase-4 inhibitor vildagliptin and the sulphonylurea gliclazide in combination with metformin, in Muslim patients with type 2 diabetes mellitus fasting during Ramadan: Results of the VECTOR study. Curr Med Res Opin. 2011;27(7):1367–74.PubMedCrossRefGoogle Scholar
- 22.Peeters, B., et al. Ramadan fasting and diabetes: An observational study among Turkish migrants in Belgium. Prim Care Diabetes. 2012; p. 293–6.Google Scholar
- 24.Amin, M., Pharmacists’ Role in Adjusting Medication Regimens for Muslim Patients in Ramadan, University of Wisconsin-Madison: Madison, Wisconsin; 2013.Google Scholar
- 26.Begum Y. GP guide to managing patients who wish to fast during Ramadan. Prescriber. 2011;22(13–14):14–21.Google Scholar
- 31.Qaisi VG. Increasing awareness of health care concerns during Ramadan. J Am Pharm Assoc (Wash). 2001;41(4):511.Google Scholar
- 33.Wilbur, K., Al-Tawengi K, Remoden E, How do pharmacists advise diabetes patient self-management during the holy month of Ramadan?, in ISPOR 15th Annual European Conference. 2012: Berlin, Germany.Google Scholar