The effect of ramadan fasting on diabetes control in type II diabetic patients

The impact of Ramadan fasting on metabolic profile among type 2 diabetes mellitus patients: A meta-analysis

BACKGROUND AND AIMS

Majority of Muslims with type 2 diabetes mellitus (T2DM) fasted during Ramadan regardless of possible risk of complication. This systematic review aims to assess the impact of Ramadan fasting on metabolic profile and hypoglycemia event among T2DM patients.

METHODS

Literature searching was conducted on December 2019 at PUBMED, Medline (EBSCOhost), and ProQuest databases using the following keywords: Ramadan fasting, type 2 diabetes mellitus, glycemic and lipid profile, anthropometry measurements, and hypoglycemia. Observational studies in adults and published in English which analyze the glucose parameters, lipid profile, and hypoglycemia among T2DM patients during Ramadan were included in the analysis. All studies were assessed for its risk of bias using New-Castle Ottawa Scale. The heterogeneity of the studies was analyzed using I² (square) test and the overall mean difference between studied parameters before and after Ramadan fasting was calculated using Weighted Mean Difference (WMD) test using Stata 13.

RESULTS

A total of 28 observational studies that were conducted in Middle Eastern, African, and Asian countries were included. This review found decrease in FPG level by -15.28 (95% CI -17.22, -13.34) mg/dl, HbA1c by -0.27 (95% CI -0.32, -0.22)%, total cholesterol by -12.88 (95% CI -14.68, -11.09) mg/dL, LDL-C by -4.42 (95% CI -6.17, -2.66)mg/dl, HDL-C by -1.09 (95% CI -1.71 - 0.47) mg/dL, triglyceride by -2.47 (95% CI -3.69 - 1.24) mg/dL and decreased anthropometry measurement. No studies reported fatal hypoglycemia event.

CONCLUSIONS

Ramadan fasting resulted in slight improvement of overall metabolic profile and anthropometry among T2DM patients with relatively low incidence of hypoglycemia.

Effect of Ramadan fasting on incidence of cerebrovascular stroke in Egyptian patients with Type 2 Diabetes Mellitus

Diabetes is an independent risk factor for stroke disease. Fasting during Ramadan, Muslims must abstain from eating, drinking, taking oral medications, and smoking from the exact time of dawn until time of sunset; in this study we investigated if there is impact of Ramadan Fasting on incidence of Cerebrovascular stroke among Patients with Type 2 Diabetes Mellitus. This cross sectional study was conducted in medical ICU of Zagazig University Hospitals, in months of Sha'ban, Ramadan and Shawwal, in 1436; total numbers of 220 patients diagnosed as cerebrovascular stroke were enrolled in. All of them were subjected to: full history taking and clinical examination, routine investigations and special investigations (CT brain & MRI brain). RESULTS: There was no significant difference in total frequency of Cerebrovascular stroke (ischemic, hemorrhagic) between patients with diabetes admitted during the month of Ramadan and other months before or after. However, during Ramadan, there was numerical but statistically not significant increase in number of patients with ischemic stroke than hemorrhagic stroke. CONCLUSION: Fasting during Ramadan does not increase the frequency of hospitalization for stroke as whole. Although; there is numerical increase in frequency of ischemic stroke than hemorrhagic stroke.

Glycemic effects of vildagliptin in patients with type 2 diabetes before, during and after the period of fasting in Ramadan

OBJECTIVE

To study the incidence of hypoglycemia, glycemic control and body weight changes in patients with type 2 diabetes treated with vildagliptin and metformin versus another group treated with sulphonylureas and metformin during and after the period of fasting in Ramadan.

PATIENTS AND METHODS

This is a randomized open-label clinical trial that recruited 69 patients previously treated with a combination therapy of metformin and sulphonylurea. Patients in the control group were maintained on their usual metformin and sulphonylurea regimen with dose adjustment for the fasting period. Patients in the study group were given vildagliptin 50 mg twice daily (at Suhur and at Iftar). One group remained on the previous background therapy unchanged and the other group was switched from sulphonylurea to vildagliptin in combination with metformin. Four visits were scheduled, one before the beginning of Ramadan (baseline), a second visit at mid Ramadan, a third at the end of Ramadan and a final visit 1 month after the end of Ramadan. At every visit, patients were assessed for hypoglycemic events and patient education was given on lifestyle needs and hypoglycemia monitoring and management.

RESULTS

The calculated change in hemoglobin A1c from baseline to last visit was similar for both groups. The incidence of hypoglycemia during Ramadan was higher in the control group (26 episodes versus 19 episodes in the study group); this result was not statistically significant (p = 0.334). However, the number of patients who dropped out from the study because of discomfort due to treatment and fear of hypoglycemia was higher in the control group.

CONCLUSION

For patients who insist on observing the fast, physicians can allow it only with close follow up and monitoring for hypoglycemic events, and vildagliptin may be a better agent than sulphonylurea.

Glycaemic trend during Ramadan in fasting diabetic subjects: a study from Pakistan

The aim of this questionnaire based survey was to assess the glycaemic control care and management of our fasting diabetic subjects. This retrospective study was carried out at Baqai Institute of Diabetology and Endocrinology, its affiliated centers and Memon Diabetic Centre of Karachi. Data was collected by a questionnaire including socio-demographic data, duration of diabetes, life style, diet and treatment during and preceding Ramadan of year 2004. All Known diabetic Muslim subjects except children below 10 years were included. The subjects were asked if they had observed any of the hypoglycemic or hyperglycemic symptoms. The major severity of the symptoms was assessed depending upon the assistance needed. The plasma glucose level during these episodes was recorded where it was available. During the month of Ramadan 327 out of 453 subjects (72.5%) fasted. Mean age of subjects was 50.3 +/- 12.6 years. Average duration of diabetes was 9.3 +/- 7.3 years. Majority of the subjects (96.3%) fasted with type 2 diabetes while only 3.7% fasted with type I diabetes. Subjects fasted for an average of 25 days. Overall prevalence of hypoglycemia and hyperglycemia was 21.7 and 19.8%, respectively. Only 4.0% had major hypoglycemic episodes, while 8% had major hyperglycemic episodes. The present study suggests that all diabetic subjects who intend to fast should be counseled before Ramadan about change in medication timings and dose, dietary changes and pattern of physical activity and about role of self-monitoring of blood glucose especially during acute symptoms.

Type 2 Diabetes and its Characteristics during Ramadan in Dhahira Region, Oman

OBJECTIVE

The main objective of this study is to illustrate the various characteristics including care of patients and changes in lifestyle of type 2 diabetics during Ramadan in Dhahira region, Oman.

METHODS

This was a hospital-based study conducted during the month of Ramadan in 2006. Of the 453 recruited, 334 (73.7%) with complete data were analyzed. Student t test was used for comparison of means and Chi-square test for proportions.

RESULTS

We analyzed 334 patients with type 2 diabetes. The common complication associated with diabetes was coronary artery disease (19.5%) and nearly 60% of the study subjects had hypertension as co-morbidity. There was little or no change in the lifestyle activities and Insulin/Oral AntiDiabetic Drug (OAD) doses during Ramadan. Majority of diabetics had poorly controlled Fasting Blood Sugar (FBS) and Body Mass Index (BMI). The overall mean weight change was -0.49 ± 1.54 SD. There was a significant weight loss during Ramadan (p<0.05).

CONCLUSION

The large proportions of uncontrolled type 2 diabetes patients in our region represent a challenge to our physicians during Ramadan. There is a need to improve diabetic management and intensive education before fasting. Clear guidelines for diabetic management including uncontrolled diabetics during Ramadan are essential in Oman.

Diabetes and Ramadan: review of the literature

During the month of Ramadan, Muslims fast every day from dawn to sunset. In the healthy subject, this fasting does not have any harmful consequences on health. However, it can induce several complications for patients with diabetes. The aim of this review twofold: first, it seeks to give some clues about methodological aspect of research during Ramadan and to show the impact of various diabetes monitoring and treatment, including biochemical and clinical parameters, diet and caloric intake, drug intake when fasting. Second, it intends to determine whether or not Ramadan fasting induces complications in patients with types 1 and 2 diabetes and ultimately to elaborate some advice as to the management of fasting patients. Several studies have shown that Ramadan fasting did not alter biochemical parameters in patients with type 2 diabetes. However, other studies have shown that there is either an increase or a decrease in biochemical parameters during Ramadan. Ramadan fasting would be acceptable for patients with well-balanced type 2 diabetes who are conscious of their disease and compliant with their diet and drug intake. If patients with type 1 diabetes wish to fast, it is necessary to advise them to undertake control of their glycaemia several times a day. Patients with type 1 diabetes who will fast during Ramadan may be better managed with fast absorption insulin.

Insulin therapy during Ramadan fast for Type 1 diabetes patients

Patients with Type 1 diabetes (T1D) are normally exempt from the Ramadan fast; however, some patients insist on following the fast, often without the approval of their physicians. The aim of this study is to provide patients with T1D, who insist on fasting, with the most appropriate insulin regimen during the month of Ramadan. Seventeen patients with T1D who insisted on fasting were studied. Prior to Ramadan, the intermediate insulin was changed to ultralente in all patients. The total dose of insulin given to fasting patients by the end of Ramadan (45.7 +/- 14.4 U/day) was less than the total dose of insulin given before fasting (52.8 +/- 13.1 U/day) p<0.05. The ultralente and regular insulin constituted 70 and 30%, respectively, of the total insulin dose by the end of Ramadan, divided equally between Suhur (before sunrise) and Iftar (after sunset). There was no change in the glycosylated hemoglobin before and after fasting. Patients were instructed to break their fast after any episode of hypoglycemia. There were no severe daytime hypoglycemia episodes. We recommend that patients with T1D wishing to fast be switched to long acting insulin such as ultralente. The total insulin dose should consist of around 85% of their initial insulin dose and it should be composed of around 70% ultralente and 30% rapid insulin, divided equally between Suhur and Iftar.

Management of people with diabetes during Ramadan

In the UK, Islam is the second largest religion after Christianity and there are about 2.5 million Muslims living in the UK. Fasting is obligatory for all healthy adult Muslims during the holy month of Ramadan. During Ramadan, no food, drink, or medication is allowed between dawn and sunset. As a result of different research results there is no agreement on whether it is safe for Muslim diabetics to fast. Through dialogue between health professionals and patients, it is usually possible to facilitate at least some safe fasting for those who wish to observe this annual ritual. In this article some key pointers will be given for health professionals to consider with the aim of improving the quality of care of Muslim patients with diabetes during Ramadan.

Muslims with non-insulin dependent diabetes fasting during Ramadan: treatment with glibenclamide

OBJECTIVE

To compare the efficacy of two glibenclamide regimens in patients with non-insulin dependent diabetes who were fasting during Ramadan and regular glibenclamide treatment in the non-fasting group.

DESIGN

Non-randomised control group of patients who did not fast during Ramadan and two groups of patients who fasted randomised equally to one of two regimens: to take their usual morning dose of glibenclamide in the evening and their usual evening dose before dawn; or to follow this pattern but to reduce the total dose by a quarter.

SETTING

Two university hospitals, one private hospital, and two private clinics in Casablanca and Rabat, Morocco.

SUBJECTS

591 diabetic patients (198 men, 391 women, two unspecified) with similar duration of diabetes and length and amount of glibenclamide treatment, of whom 542 completed the study.

MAIN OUTCOME MEASURES

Serum fructosamine and total glycated haemoglobin concentrations and number of hypoglycaemic events.

RESULTS

At the end of Ramadan there were no significant differences between the groups in fructosamine concentration (400 mumol/l in controls and 381 mumol/l and 376 mumol/l in the fasting groups); percentage of glycated haemoglobin (14.7%, 14.0%, and 13.6%); or number of hypoglycaemic events during Ramadan (11, 14, and 10).

CONCLUSION

Glibenclamide is effective and safe for patients with non-insulin dependent diabetes who fast during Ramadan. The easiest regimen is to take the normal morning dose (together with any midday dose) at sunset and any evening dose before dawn.

Ramadan fasting: Medical aspects in health and in disease

Ramadan fasting is one of the Pillars of Islam. Its observance involves abstinence from eating and drinking from dawn until sunset during the entire holy month. The effects of Ramadan fasting on body physiology as well as on the different biochemical, hematological, and metabolic parameters are reviewed. Metabolic changes, when present, are mild and reversible. The effects of fasting on diabetes mellitus, treatment with nonsteroidal antiinflammatory agents, and anticoagulation therapy are discussed.