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7-fold (from 3 to 14 events/100 people/month) in type 1 diabetes and 7.5-fold (from 0.4 to 3 events/100 people/month) in type 2 diabetes. The incidence of severe hyperglycaemia in patients with type 2 diabetes also increased fivefold 16. In a multicentre observational study (n = 1374), symptomatic hypoglycaemia occurred in about 20% of diabetic patients on sulphonylurea with or without metformin who fast during Ramadan 17, whilst other studies have not shown a significant increase in the risk of hypoglycaemia during Ramadan in patients treated with oral diabetic medications or insulin 18, 19. Blood http://www.selleckchem.com/products/obeticholic-acid.html glucose monitoring does not constitute a break of fast 20. All patients who fast should be provided with the means to monitor their blood glucose 21. Continuous glucose monitoring has been shown to improve overall mean glucose, reduce glycaemic excursions and reduce time spent in hyperglycaemia in non-fasting type 2 diabetes subjects 22. Although it has not been studied, continuous glucose monitoring may be a useful tool in studying the glycaemic variability during Ramadan in patients with a history of hypoglycaemia and http://www.selleckchem.com/products/Adriamycin.html in raising an alarm if there is rapid decrease in glucose or pending hypoglycaemia. A pre-Ramadan assessment of patients who wish to fast during Ramadan is recommended to assess whether their health risk increases by doing so 23. Other opportunities for discussions about fasting during Ramadan can be at the time of diagnosis and at an annual diabetes review. Consensus guidelines have categorized patients according to their health risks 23, 24. Patients in the high-risk category should be advised not to fast while those in the low risk can be allowed to fast. Those in the medium category should discuss with healthcare professionals their management of Ramadan several months before Ramadan to reduce their risks. Muslim religious leaders also play an important role in the education regarding religious fasting, especially for patients with diabetes who are keen to fast but overlook the risks involved, and also for patients who do not wish to fast but do so in order not to alienate themselves from the rest of the Muslim community 25. Both religious http://www.selleck.cn/products/LY294002.html leaders and healthcare professionals are crucial in providing education and support for safer fasting during Ramadan. In a systematic review of randomized controlled trials of the effectiveness of self-management training in people with type 2 diabetes, educational interventions that involved patient collaboration were more effective than didactic interventions in improving glycaemic control (