British Muslims with diabetes may avoid attending GP surgeries to discuss fasting during the holy month of Ramadan – with potentially serious consequences for their future health.
The first study in the UK to explore the beliefs which influence the experience and practices of British Muslims’ diabetes management found tensions often exist between observing the important religious ritual in accordance with their faith and the competing need to manage their health.
Lead author and CLAHRC Greater Manchester Researcher Dr Neesha Patel said the research, published in Health Expectations, showed British Muslims with diabetes would like support and advice from their GP on fasting safely, providing their GP was trained, emphatic and understood the significance of Ramadan for Muslims with diabetes.
There are three million people in the UK with diabetes, and a further 850,000 who have undiagnosed type 2. It is six times more common in the South Asian population and four times more common in the Bangladeshi and Pakistani groups than the general UK population. Recent figures suggest approximately 325,000 Muslims have diabetes in the UK. Short-term risks of fasting include poor diabetes control and dehydration. Longer-term risks include a reduced quality of life and increase in mortality.
The research, by the universities of Manchester and Keele and funded by CLAHRC GM, found many saw fasting during Ramadan as a religious duty which should be fulfilled by all Muslims in spite of living with diabetes. Some avoided telling their GP or practice nurse they were fasting. While those who did inform their GP reported that they were advised not to fast but went ahead anyway because they felt they could control their diabetes or that their GP did not understand the significance of fasting during Ramadan.
The reluctance to disclose fasting was not influenced by the ethnicity of the GP. Regardless of whether the GP was Pakistani Muslim or white British some respondents still perceived their GP to have a lack of expertise to support them effectively during fasting. Five type-2 diabetes patients interviewed who were on insulin did not fast and perceived it as a threat to their diabetes. But some patients reported receiving pressure from their family to fast as well as guilt and embarrassment at not fasting. Some reported eating their daytime meals in secret or when other family were not in the house.
Dr Patel said: “Although the Islamic law states that the ‘sick’ can be exempt from fasting for one or all 30 days, the majority of Muslim respondents with diabetes do not perceive themselves as ‘sick’ and therefore choose to fast.
“We found many British Muslims we interviewed did not bring the topic up with their GP or practice nurse or avoided their surgery altogether that month for fear of being told not to fast.
“The reluctance to disclose fasting to GPs or practice nurses has potentially serious consequences for diabetes control and future health. Non-adherence to daily diabetes regime may result in more Muslim patients suffering the risks and complications associated with diabetes, leading to poor quality of life and increased use of NHS health services.”