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Int J Nurs Stud. 2019 Jul;95:65-72. doi: 10.1016/j.ijnurstu.2019.04.020. Epub 2019 May 11.

Effectiveness of Managing Diabetes During Ramadan Conversation Map intervention: A difference-in-differences (self-comparison) design.

Author information

Department of Nursing, University of Haifa, Haifa, Israel; Clalit Research Institute, Clalit Healthcare Services, Tel Aviv, Israel. Electronic address:
Clalit Research Institute, Clalit Healthcare Services, Tel Aviv, Israel.
Eli Lilly, West Ryde, New South Wales, Australia.
Eli Lilly and Company, United States.
Community Nursing Division, Clalit Healthcare Services, Tel Aviv, Israel.
Eli Lilly, Ruhama, HaDarom (South) District, Israel.
Eli Lilly, Sydney, Australia.



Some individuals with diabetes fast during Ramadan despite medical concerns for risk of adverse outcomes. The Managing Diabetes During Ramadan Conversation Map is a self-management education group-based intervention for Muslim individuals with type 2 diabetes, specifically addressing diabetes management during Ramadan.


The aim of this study was to evaluate the effectiveness of the Managing Diabetes During Ramadan Conversation Map intervention in improving short-term clinical outcomes and reducing healthcare utilization following Ramadan.


This was a retrospective rolling cohort study.


Participants were Clalit Health Services members with type 2 diabetes who participated in the intervention between 2014 and 2017 across Israel.


This study included 1732 participants who enrolled in the intervention over the five-year study period. The cohort was mainly between the ages of 45 and 74 years (83.3%), female (71.9%), of lower socioeconomic status (92.1%), with a diabetes duration of 10 years or more (51.7%), obese (64.0%), and had never smoked (73.8%).


The data used in this study came from Clalit Health Services' electronic health records, which are integrated in a central data warehouse. We used a difference-in-differences (self-comparison) design to examine the effect of the intervention on changes in laboratory results and healthcare utilization over a six month baseline and follow-up. Mixed model linear regressions and Poisson regressions were used to estimate continuous and count outcomes, respectively.


Post intervention, participants experienced a reduction of 8.61 mg/dL in their glucose levels (p = 0.005) and 0.34% in their HbA1c levels (p < 0.001). In a sub-group analysis of participants with HbA1c > 7%, larger reductions in glucose (17.02 mg/dL [p < 0.001]) and HbA1c (0.63% [p < 0.001]) levels were recorded. This sub-group also experienced a reduction of 4.83 mg/dL in LDL level (p = 0.007) and had 0.2 fewer primary care visits (p < 0.001).


Participation in the Managing Diabetes During Ramadan Conversation Map improved patient glucose and HbA1c levels. A greater benefit was reported in those individuals with HbA1c > 7%. These findings hold important global health implications for the millions of individuals with type 2 diabetes for whom Ramadan can pose a challenge in disease control.


Diabetes conversation map; Diabetes mellitus; Program evaluation; Ramadan; Self-management; Type 2

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