Effect of Ramadan fasting on diabetes mellitus: a population-based study in Qatar

Responsibilities of General Practitioners Regarding Diabetes Mellitus During the Month of Ramadan

Muslims practice fasting during the ''holy month of Ramadan'', which poses special difficulties for those who have diabetes. Studies show that a sizable fraction of people with type 1 and type 2 diabetes fast despite the health hazards that come with the condition. This indicates that the incidence of diabetes among Muslims who fast is noteworthy. An increased vulnerability to acute problems, such as hypoglycemia, hyperglycemia, and diabetic ketoacidosis, is caused by extended fasting periods, irregular eating and sleeping routines, and changes in medication regimens. Healthcare professionals (HCPs), especially General Practitioners (GPs), should be involved in advising patients on safe fasting practices to strike a balance between religious observance and medical guidance. While guidelines from groups such as the Diabetes and Ramadan International Alliance and the International Diabetes Federation provide helpful suggestions, GPs are responsible for ensuring patient safety during Ramadan, particularly in areas where access to diabetes specialists is restricted. GPs are essential in managing diabetes-related issues before and throughout Ramadan, as well as in providing organized education and increasing awareness. A GP's primary responsibility at this time is to oversee the timely referral of high-risk patients and to effectively communicate with patients. To increase public awareness and support for diabetes care during Ramadan, it is also advised to work with religious leaders and make use of social media channels. It is ultimately in line with medical and religious beliefs to prioritize diabetes treatment during Ramadan, emphasizing the critical role general practitioners play in preserving the health and well-being of diabetics who are fasting.

Does Ramadan Intermittent Fasting Affect the Fasting Blood Glucose Level among Type II Diabetic Patients?

BACKGROUND

The level of fasting blood glucose (FBG) is influenced by several factors, including health status, genetics, and diet. Some studies have reported a beneficial effect of Ramadan Intermittent Fasting (RIF) on diabetic patients. However, clinical observations have shown that diabetes is exacerbated in some patients.

AIM

This study aims to investigate the influence of RIF on the FBG level, a biomarker of hyperglycemia and diabetes, and to identify factors associated with variations in FBG levels during RIF among diabetic patients.

METHODS

This study is a cross-sectional study. We monitored the FBG levels of 181 type II diabetic patients over a two-month period, from 20 February to 20 April 2023, which represents the Islamic lunar months of Shaban (8th month) and Ramadan (9th month). Ramadan provides a prominent month of intermittent fasting practice for studying its physiological effects on diabetes. We collected clinical data from each participant, including demographic information, co-morbidities, and medications used during this period.

RESULTS

Based on our findings, diabetic patients were classified into three groups depending on the influence of RIF on FBG levels: the positively affected group (44%), whose average FBG levels were reduced; the neutrally affected group (24%), whose average FBG levels did not change; and the negatively affected group (32%), whose average FBG levels increased during the fasting month of Ramadan compared to the previous month. Furthermore, we found that the positive effect of RIF was more frequent among obese, non-geriatric, and male diabetic patients, while the negative effect of RIF was more frequent among patients who were not adhering to the medication.

CONCLUSIONS

This study concludes that RIF affects FBG levels differently among diabetic patients. These findings should be taken into consideration when treating diabetic patients during the fasting month of Ramadan, and further studies are needed to identify (1) factors associated with inter-individual variation in the response to RIF and (2) those who are great candidates for RIF.

Effects of Ramadan Fasting on Glycaemic Control Among Patients with Type 2 Diabetes: Systematic Review and Meta-analysis of Observational Studies

INTRODUCTION

The prevalence of type 2 diabetes (T2D) is increasing around the world. Although Muslims with a physical illness are exempted from fasting during the month of Ramadan, a great number still choose to fast, often without medical consultations. The aim of this systematic review and meta-analysis was to investigate the impact of observing Ramadan fasting (RF) on glycaemic control in patients with T2D.

METHODS

The Web of Science, Scopus, EBSCOhost, CINAHL, ScienceDirect, Cochrane Library, ProQuest Central and Europe PubMed Central (Medline) databases were searched for relevant studies published between January 2000 and December 2021. Observational studies that examined the changes in body weight (BW) and glucose parameters (glycosylated haemoglobin [HbA1c] and fasting blood glucose [FBG]), before and after RF among different age groups with T2D were included in the systemic review and meta-analysis. Effect sizes for the tested outcomes were calculated as weighted mean difference (WMD), with their confidence intervals (CI). Quality assessment was examined using the National Heart, Lung, and Blood Institute (NHLBI) tool.

RESULTS

Of the 1592 identified records, 12 studies conducted in Middle Eastern and Asian countries were eligible and included in the quantitative analyses. The quality of the retrieved studies was evaluated and found to range between fair (83%) and good (17%). These 12 studies included 5554 participants of whom 54% were males and 46% were females. Our pooled analysis demonstrated that HbA1c and FBG levels significantly decreased after RF when compared to the pre-fasting levels (WMD = 0.55 mg/dl, 95% CI 0.33-0.77, P < 0.00001, Ι² = 93% and WMD = 12.42, CI 6.46-18.38, P < 0.0001, Ι² = 81%, respectively). However, the difference in BW in fasting patients after RF versus the pre-fasting stage was non-significant. Although, young patients with T2D were enrolled in the 12 selected studies, we did not find any studies that solely focussed on this group.

CONCLUSION

The impact of RF on adult patients with T2D is associated with favorable outcomes. However, future studies should evaluate data from young adults separately. In addition, it is essential to identify the effects of the number of fasting days (level of exposure), diet, level of physical activity and sleeping pattern on optimal glycaemic control. This information could be utilized by medical professionals as a non-pharmacological therapeutic method for management of diabetes in patients who are willing to practice fasting during Ramadan and other months of the year.

STUDY REGISTRATION

PROSPERO: CRD42022314752.

Islamic fasting: cardiovascular disease perspective

INTRODUCTION

Ramadan is a month of obligatory fasting observed by the majority of 2 billion Muslims living around the globe. The guidelines for 'risk-free' fasting exist for chronic diseases, including diabetes mellitus, but recommendations for cardiovascular disease (CVD) patients are deficient due to the paucity of literature.

AREAS COVERED

Databases were screened to find relevant studies for an evidence-based consensus regarding the risk stratification and management of CVD. Using practical guidelines of the European Society of Cardiology (ESC), we categorized patients into low-, moderate-, and high-risk categories and proposed a pre-Ramadan checklist for the assessment of cardiac patients before fasting. Regular moderate-intensity exercise is recommended for most cardiac patients, which has been demonstrated to provide an anti-inflammatory and antioxidant effect that improves immune function.

EXPERT OPINION

In Ramadan, many physiological changes occur during fasting, which brings about a balanced metabolic homeostasis of the body. In addition, Ramadan fasting is a nonpharmacologic means of decreasing CV risk factors. As Islam exempts Muslims from fasting if they are unwell; therefore, patients with the acute coronary syndrome (ACS), advanced heart failure (HF), recent percutaneous coronary intervention (PCI), or cardiac surgery should avoid fasting.

Sex as a Biological Factor in the Changes in Disease Patients During Ramadan Intermittent Fasting: A Systematic Review

Background

During Ramadan, many patients with diabetes, renal, cardiovascular, gastrointestinal diseases, headaches, and epilepsy choose to fast even against their doctor's advice. The impact of this intermittent fasting on health and disease could be different in men and women. The aim of this study was to determine the effect of sex as a factor in diseases outcomes of patients who opt to fast during Ramadan.

Main Body

The articles included in this study reported data on six diseases: diabetes, renal, cardiovascular, gastrointestinal diseases, headaches, and epilepsy. A systematic search was performed on PubMed and Scopus for observational and clinical studies mentioning Ramadan, diabetes, renal, cardiovascular, gastrointestinal diseases, headaches, and epilepsy in both men and women. Data was extracted by two independent reviewers using a standardized data-collection form. From 381 original articles, 38 studies were selected, including 25,023 patients of which 44.4% were women. Sex-based differences were reported by 18 studies for several variables such as body mass index, blood glucose, the frequency of hypoglycemia, renal colic, mortality, thrombosis, and gastrointestinal diseases in patients fasting during Ramadan. Most of the differences between men and women were reported both in the baseline period before Ramadan and during Ramadan. Indeed, during the period outside Ramadan, the frequency of renal colic, cardiovascular, gastrointestinal diseases, were higher in men; while body mass index, Thrombosis, and headache were higher in women. In the remaining 21 studies, it was reported that the sex factor was not associated with the effect of Ramadan fasting in the frequency and other outcomes of these diseases.

Conclusion

Currently, small attention is paid to sex as a determinant factor in patients while fasting during Ramadan. There appeared to be differences in the frequency and incidence of diseases in men and women during Ramadan. Closer attention to sex differences regarding the frequency and the progression of the diseases during fasting may help to improve patient care, especially to benefit those patients willing to fast during Ramadan.

Impact of Ramadan intermittent fasting on metabolic and inflammatory profiles in type 2 diabetic patients

Purpose

The aim of this study was to assess the impact of Ramadan intermittent fasting on metabolic and inflammatory profiles in type 2 diabetic patients (T2D).

Methods

It was a prospective study including 55 T2D patients treated with oral hypoglycemic drugs, who intended to observe Ramadan fasting in 2019. All participants underwent a questionnaire, a physical examination, laboratory investigations, and a cardiovascular risk assessment using the Framingham score before Ramadan (T0), immediately after Ramadan (T1), and two months after Ramadan (T2).

Results

The mean age of participants was 54.5 ± 10.1 years. The number of fasted days was 29.3 ± 2.3 days. The mean total daily calorie intake decreased significantly by 19% during Ramadan (p < 10^-3). A significant decrease in weight (79.8 ± 12.9 vs 78.4 ± 13.3 kg, p = 0.003), body mass index (29.8 ± 5.4 vs 29.2 ± 5.4 kg/m², p = 0.004), waist circumference (98.2 ± 9.6 vs 96.3 ± 10.2 cm, p = 0.015), fat body mass (24.3 ± 9.4 vs 23.5 ± 9.7 kg, p = 0.043) was observed at T1. The weight loss was significantly correlated with the number of fasting days (r = 0.348, p = 0.009) and was maintained at T2. Serum fructosamine increased at T1 (303.6 ± 46 vs 333.49 ± 59.49 µmol/L, p < 10^-3) and returned to its baseline levels at T2. A significant decrease in insulin (9.7 ± 5.5 vs 7.98 ± 5.05 mIU/L, p = 0.043), fibrinogen (3.7 ± 0.8 vs 3.4 ± 0.6 g/L, p = 0.003), and hs-CRP (4.8 ± 5.7 vs 3.7 ± 4.5 mg/L, p = 0.058) levels was observed at T1. Homocysteine level was significantly higher after Ramadan (12.2 ± 6.2 vs 13.5 ± 6.4 µmol/L, p = 0.001). However, no significant changes were found in blood pressure, fasting blood glucose, HOMA-IR, uric acid, lipids, and white blood cells count. The mean Framingham score decreased insignificantly after Ramadan.

Conclusions

Ramadan fasting in T2D patients seems to have a favorable impact on anthropometric parameters and inflammatory profile. However, it may cause a transient worsening of glycemic control.

Ramadan Fasting and Maternal and Fetal Outcomes in Pregnant Women with Diabetes Mellitus: Literature Review

There is an emerging Muslim and diabetic population in the United States and other Western countries and majority of pregnant women and patients with diabetes mellitus choose to fast during Ramadan. Fasting during Ramadan in pregnant women with diabetes may represent a 'perfect storm' of metabolic disturbances including hyperglycemia, hypoglycemia and ketosis. Recent continuous and flash glucose monitoring data suggests increased glycemic variability (fasting hypo- and post-Iftar hyperglycemia) in non-pregnant patients with diabetes during Ramadan. Only five small-scale studies, predominantly focused on women with gestational diabetes mellitus in Muslim-majority nations have explored maternal glycemic outcomes during Ramadan which is associated with lower mean blood glucose levels and higher frequency of fasting hypoglycemia. Data is limited however on important clinical outcomes such as symptomatic and serious hypoglycemia requiring hospitalization. Results have been conflicting regarding maternal Ramadan fasting and association with fetal outcomes in women without diabetes. Only one recently published study reported on perinatal outcomes in pregnant women with gestational diabetes which found no effect of Ramadan exposure on mean birthweight or macrosomia frequency but lower neonatal hypoglycemia prevalence, however a significant limitation was lack of documentation of maternal fasting status. At this stage, due to paucity of data, the current medical recommendation is against Ramadan fasting for pregnant Muslim women with diabetes. Large-scale population-based studies are warranted regarding maternal and fetal outcomes in pregnant fasting women with diabetes and such studies should characterize maternal fasting status and have meaningful and consistent clinical outcomes. High-quality data derived from these studies can assist clinicians in providing more evidence-based advice to safely navigate both mother and fetus through a potentially challenging pregnancy.

Effect of Religious Fasting in Ramadan on Blood Pressure: Results From LORANS (London Ramadan Study) and a Meta-Analysis

Background Ramadan fasting is practiced by hundreds of millions every year. This ritual practice changes diet and lifestyle dramatically; thus, the effect of Ramadan fasting on blood pressure must be determined. Methods and Results LORANS (London Ramadan Study) is an observational study, systematic review, and meta-analysis. In LORANS, we measured systolic blood pressure (SBP) and diastolic blood pressure (DBP) of 85 participants before and right after Ramadan. In the systematic review, studies were retrieved from PubMed, Embase, and Scopus from inception to March 3, 2020. We meta-analyzed the effect from these studies and unpublished data from LORANS. We included observational studies that measured SBP and/or DBP before Ramadan and during the last 2 weeks of Ramadan or the first 2 weeks of the month after. Data appraisal and extraction were conducted by at least 2 reviewers in parallel. We pooled SBP and DBP using a random-effects model. The systematic review is registered with PROSPERO (International Prospective Register of Systematic Reviews; CRD42019159477). In LORANS, 85 participants were recruited; mean age was 45.6±15.9 years, and 52.9% (n=45) of participants were men. SBP and DBP after Ramadan fasting were lower by 7.29 mm Hg (-4.74 to -9.84) and 3.42 mm Hg (-1.73 to -5.09), even after adjustment for potential confounders. We identified 2778 studies of which 33 with 3213 participants were included. SBP and DBP after/before Ramadan were lower by 3.19 mm Hg (-4.43 to -1.96, I2=48%) and 2.26 mm Hg (-3.19 to -1.34, I2=66%), respectively. In subgroup analyses, lower blood pressures were observed in the groups who are healthy or have hypertension or diabetes but not in patients with chronic kidney disease. Conclusions Our study suggests beneficial effects of Ramadan fasting on blood pressure independent of changes in weight, total body water, and fat mass and supports recommendations for some governmental guidelines that describe Ramadan fasting as a safe religious practice with respect to blood pressure.

Does Ramadan fasting have effects on sleep, fatigue and blood pressure among patients with hypertension?

AIM

The aim of this study was to determine the effect of Ramadan fasting on blood pressure (BP), fatigue, sleeping and physical activity among hypertensive patients.

SUBJECTS AND METHODS

A cross-sectional study was conducted from April 2019 to July 2019. Of the total 1500 hypertensive patients approached, 1118 (74.5%) gave their consent. Data analysis included sociodemographics, lifestyle habits, anthropometric measurements and clinical biochemistry parameters at baseline, and after 3 months.

RESULTS

Out of 1118 subjects, 593(47.6%) were male and 653(52.4%) were female. There were statistically significant differences between males and females regarding age groups in years, educational level, occupational status, income, smoking habits, physical exercise, sports activities and fatigue. There were statistically significant differences for the biochemistry parameters regarding vitamin D, blood glucose, HbA1c level, creatinine, bilirubin, albumin, total cholesterol, triglycerides, HDL-C, LDL-C, uric acid and SBP for both males and females after the holy month of Ramadan as compared to before Ramadan. Also, BMI was significantly lower during the after month of Ramadan as compared to before Ramadan (P < 0.001). Multiple linear regression analysis results revealed that less hours of sleeping (P < 0.001), SBP (mmHg) (P < 0.001), DBP (mmHg) (P < 0.001), family size (P = 0.002), obesity BMI (kg/m2) (P = 0.013), fatigue (P = 0.022) and smoking cigarette (P = 0.029) were identified as statistically significant predictors of hypertensive patients with Ramadan fasting as contributing at higher risk factors.

CONCLUSION

This study confirmed that fasting during Ramadan has no effect on the BP, blood glucose, HbA1C level, sleep quality, fatigue and BMI among hypertensive patients.

[Management of diabetes during Ramadan fasting: applications of international recommendations in clinical practice]

Le jeûne n’est pas sans risques chez les patients diabétiques. L’objectif de notre étude est d’évaluer l’impact du jeûne chez une cohorte de patients diabétiques ayant bénéficié d’une préparation au jeûne avec ajustement des traitements selon les recommandations de l’association américaine du diabète (ADA) en 2010. Il s’agit d’une étude prospective de cohorte menée en 2014, incluant des patients diabétiques désirants jeûneer au cours du mois de Ramadan consentant pour participer à l’étude. Nous avons exclu les patients considérés comme à très haut risque selon la classification de l’ADA. Les patients ont bénéficié d’une consultation avant le mois du Ramadan (J0) comprenant éducation et ajustement du traitement, suivi d’une consultation au cours du Ramadan (J7) puis à J30 et à J60. Notre étude a inclus 34 patients, dont 60% sont des femmes, d’âge moyen de 50,4 ans avec une ancienneté moyenne du diabète de 6,2 ans et un index de masse corporelle (IMC) moyen de 27,83 kg/m². Les ajustements thérapeutiques réalisés (J0) étaient une diminution de la dose de sulfamides hypoglycémiants (SH) et la mise sous gliptine chez les patients à risque hypoglycémique, ainsi qu’une répartition de la dose de metformine. Au cours de la première semaine (J7), deux patients ont présenté une glycémie inférieure à 0,7g/l avant la rupture du jeûne, 38% de l’échantillon ont présenté une glycémie >2g/l après la rupture du jeûne. Nous avons noté des erreurs diététiques chez 15% des patients. L’ajustement à (J7) a consisté à adapter la dose du SH ou à ajouter une gliptine. Aucun patient n’a présenté d’hyperglycémie majeure, de cétose ou d’hypoglycémie grave. Une patiente a présenté une arythmie complète par fibrillation atriale (ACFA) sur cardiopathie ischémique méconnu avec arrêt du jeûne. Trois patients ont arrêté le jeûne entre J15 et J20 devant une asthénie intense sans déséquilibre glycémique. La moyenne d’HBA1C chez les patients après le jeûne était de 7,10 versus 6,8% avant le jeûne (p=0.42). Les facteurs significativement associés au déséquilibre glycémique après le jeûne avec des HBA1C > à 8% étaient principalement les taux d’HBA1C de départ (p=0.002), l’absence d’autosurveillance (p=0.01), et l’ancienneté du diabète (p=0.06). Une bonne évaluation du niveau de risque du patient, une éducation thérapeutique, une autosurveillance glycémique et un ajustement du traitement selon les recommandations internationales, permettent aux patients diabétiques musulmans de diminuer le risque lié au jeûne. Néanmoins une consultation au cours du Ramadan (J7) permet une correction des erreurs diététiques et un ajustement thérapeutique si cela est nécessaire.

Ramadan Intermittent Fasting Affects Adipokines and Leptin/Adiponectin Ratio in Type 2 Diabetes Mellitus and Their First-Degree Relatives

Background

In view of the association of Ramadan intermittent fasting with profound changes in lifestyle both in nondiabetic and diabetic patients, the aim of this study was to investigate the effect of Ramadan fasting on adiponectin, leptin and leptin to adiponectin ratio (LAR), growth hormone (GH), human-sensitive C-reactive protein (hs-CRP), and diabetic and metabolic syndrome factors in patients with Type 2 Diabetes Mellitus (Type 2 DM), their first-degree relatives (FDRs), and healthy controls.

Methods

This cohort study involved 98 Yemeni male subjects aged 30-70 years old: 30 Type 2 DM, 37 FDRs of Type 2 diabetic patients, and 31 healthy control subjects. Subjects' body mass index (BMI), waist circumference (WC), and blood pressure (BP) were measured, and venous blood samples were collected twice: the first samples were collected a couple of days prior to Ramadan fasting (baseline) and the second samples after 3 weeks of fasting.

Results

Ramadan fasting did not affect BMI, WC, and BP in Type 2 DM and their FDRs with respect to the baseline levels prior to Ramadan, whereas triglyceride and cholesterol were borderline significantly decreased in Type 2 DM with no effect in FDRs. Fasting blood glucose was not affected in Type 2 DM but was significantly increased in FDRs and control groups, whereas glycated haemoglobin (HbA1c) was slightly decreased in Type 2 DM, FDRs, and healthy controls. C-peptide, insulin, and insulin resistance (HOMA-IR) were significantly increased in Type 2 DM and FDRs, with no effect in the control group, whereas β-cell function (HOMA-β) was significantly decreased in FDRs and controls with no change in Type 2 DM. Ramadan fasting significantly decreased GH in both FDRs and control groups, and significantly increased hs-CRP in the control with no effect in Type 2 DM and FDRs. Adiponectin was significantly decreased, and leptin and LAR were significantly increased in Type 2 DM, FDRs, and control groups.

Conclusion

Ramadan intermittent fasting decreased adiponectin and increased leptin, LAR, insulin, and insulin resistance in both Type 2 DM and FDRs as well as decreased GH in both FDRs and healthy controls and increased hs-CRP in healthy controls. Moreover, Ramadan intermittent fasting neither worsens a patient's glycemic parameters nor improves it, with the exception of a slight improvement in HbA1c in Type 2 DM, FDRs, and healthy controls.

The effect of Ramadan fasting on cardiovascular events and risk factors in patients with type 2 diabetes: A systematic review

Ramadan is the fasting month in Islam. Muslims around the world observe Ramadan every year, including people with diabetes. Data on the association of fasting in people with diabetes are sparse. The purpose of this study is to assess the association of fasting on cardiovascular risk factors and events in people with diabetes. A comprehensive search was conducted in the following database: Embase, Medline, Cochrane library and CINAHL. The following key terms were used: Ramadan, Ramazan, Ramadhan, Muslim, Islam and fasting. Studies were eligible if they included people with Type 2 diabetes who fasted during Ramadan and reporting results on cardiovascular risk factors or events. Overall 22 studies met inclusion criteria for the review; five studies reported cardiovascular outcomes and 17 reported changes in risk factors. There is insufficient evidence to link Ramadan fasting with increased or reduced incidence of cardiovascular events in people with diabetes, though there were some indication stroke risk may be increased. Findings were inconsistent in term of risk factors as some favoured Ramadan and others did not.‬‬‬‬.

Self-Monitoring of Blood Glucose and Hypoglycemia Association During Fasting in Ramadan Among Patients with Diabetes

PURPOSE

The study aims to assess current practices of patients with diabetes to control blood glucose levels during Ramadan.

PATIENTS AND METHODS

A cross-sectional approach has been used for collecting data through a structured and interview-based questionnaire to assess the association between self-monitoring of blood glucose (SMBG) and hypoglycemia. The questionnaire has recorded information about demographics, duration of diabetes, and treatment of diabetes, and hypoglycemia complications faced during Ramadan. The primary outcomes of this study include frequency of SMBG during fasting in Ramadan and association of SMBG and hypoglycemia and break of fasting. However, the secondary outcomes include medications, glycemic control, and other influencing factors. The data was analyzed using Statistical Package of Social Sciences (SPSS) version 20.

RESULTS

The findings have shown that the majority of the patients used a combination of metformin+sulphonylurea (23.02%) following metformin+insulin (20.86%), insulin (12.94%), and metformin (8.63%). Whereas diet control, high or low blood sugar, insulin dose adjustment in fasting conditions were the most influential factors during Ramadan when the blood sugar levels were tested. Majority of the patients monitored their blood glucose level during pre-iftar (56.8%) following to hypoglycemia (30.2%), post-iftar (29.4%), and rarely monitored in afternoon (3.5%) despite that only 10.1% monitored their blood glucose on a daily basis. Patients who had symptoms of hypoglycemia and had to break their fasting at least once were 41% and 27.2%, respectively. There is a significant association between age and gender with symptoms of low blood sugar level. Additionally, a significant association between blood sugar monitoring and high blood sugar level has been shown (p=0.041), indicating that lack in daily blood sugar monitoring can increase the blood sugar level of a patient during Ramadan.

CONCLUSION

The present study has helped in providing better understanding about the self-monitoring of blood glucose level and hypoglycemia. Furthermore, it also emphasizes the pre-Ramadan education about when to break their fasting along with frequency and timing of SMBG.

Effect of ramadan fasting on glycemic control and other essential variables in diabetic patients

Background

Fasting during the holy month of Ramadan is a religious obligation for all Muslims who represent 1.8 billion of the world population (24%). This study explores the effect of Ramadan fasting on the blood glucose, glycated hemoglobin (HbA1c), lipid profile, sleeping quality, and essential lifestyle parameters and also explores the safety of fasting for a whole month among diabetic patients.

Aim

The aim of the present study was to assess the impact of Ramadan fasting on the blood glucose, HbA1c, lipid profile, sleeping quality, and lifestyle parameters among patients with type 2 diabetes mellitus (T2DM) in Turkey.

Subjects and Methods

A total of 1780 diabetic patients were approached, and 1246 (70%) participated in this cross-sectional study carried out during the period from May 27, 2017, to June 24, 2017. Data analysis comprised sociodemographic features, lifestyle habits, blood pressure measurements, serum lipid profiles, serum calcium, Vitamin D 25-hydroxy, uric acid, and HbA1c at before 4 weeks and after 12 weeks from Ramadan.

Results

Out of 1246 patients, 593 (47.6%) were male and 653 (52.4%) were female. The mean ± standard deviation age of the patients was 50.39 ± 15.3 years. Males were significantly older than females (51.53 ± 12.56 vs. 49.26 ± 14.4; P = 0.003, respectively). Significant differences were found in Vitamin D, blood glucose, HbA1c level, creatinine, bilirubin, albumin, total cholesterol, triglycerides, high-density lipoprotein-cholesterol (female), low-density lipoprotein-cholesterol (male), uric acid, and systolic and diastolic blood pressure after and before the holy month of Ramadan (P < 0.05 for each). HbA1c (P < 0.001), physical activity (P < 0.001), hours of sleeping (P < 0.001), systolic blood pressure (BP) (mmHg) (P = 0.007), BMI (P = 0.016), diastolic BP (mmHg) (P = 0.018), family history (P = 0.021), and smoking (P = 0.045) were identified as significantly associated with Ramadan fasting as contributing factors.

Conclusion

In one of the largest studies of its kind, we show that Ramadan fasting has positive effects on T2DM patients as it reduces their blood pressure, blood glucose, HbA1C, and BMI. Furthermore, there are improvements in the duration of sleep and physical activity, the role of Ramadan fasting in diabetes therapy has been confirmed.

Effect of Ramadan fasting on renal function in patients with type 2 diabetes

AIM

To evaluate the effect of Ramadan fasting on kidney functions in patients with type 2 DM.

METHODS

We recruited 90 subjects with type 2 DM intending to fast Ramadan; classified into 30 with albuminuria and renal impairment (group I), 30 with albuminuria and normal kidney functions (group II) and 30 without albuminuria and normal kidney functions (group III). Two weeks before and after Ramadan, fasting plasma glucose, 2 h plasma glucose, hemoglobin A1c, fructosamine, serum creatinine, BUN, eGFR and albumin/ creatinine ratio were measured.

RESULTS

On comparing data before and after Ramadan, significant reduction in HbA1c was found in all groups. As regards kidney function parameters, no significant difference was found in group I but a significant decline in these parameters was found in groups II and III; serum creatinine, eGFR, urinary albumin/ creatinine ratio (p <0.001). Only Group I showed significant hypoglycemic events and need for dose reduction.

CONCLUSION

Ramadan fasting improved glycemic control in patients with type 2 DM with no decline in kidney functions in renally impaired group, only a decline in albuminuric and healthy groups within the normal range. Patients should be adviced regarding adequate hydration and dietary modification during Pre-Ramadan health care education.

Differential effects of gender and patient background diversity on the changes in metabolic and biophysical profiles in people with type-2 diabetes from different ethnicities who fast during Ramadan (H1439); a prospective study from Qatar

OBJECTIVE

The 'PROspective Study of dose adjustment of multiple anti-diabetic therapy for Type-2 diabetic patients FASTing the Month of Ramadan aimed to assess the biophysical and metabolic effects of fasting during Ramadan, including HbA1c, weight, blood pressure and lipid profile.

STUDY DESIGN METHODS

We performed a prospective study of people with Type-2 diabetes who were on ≥3 drugs for lowering glucose before and after Ramadan of H1438 (May-June 2017) in Hamad Medical Corporation, Qatar. We enrolled 228 participants, of whom 181 completed the study and were included in the analysis.

RESULTS

There were 115 (63.5%) men and 66 (36.5%) women, mean age 53.6 ± 9.7 years and mean diabetes duration of 10 ± 6 years. Both HBA1c [7.8% (62 mmol/mol) vs. 7.6% (60 mmol/mol); p = 0.004]; and diastolic BP (75.7 ± 8.55 vs. 68.8 ± 23.1 mmHg, P = 0.001) improved significantly after Ramadan while there was an increase in total cholesterol (3.94 ± 0.89 mmol/l vs 4.11 ± 1.02 mmol/l; p = 0.008) and triglycerides (1.55 ± 0.72 mmol/l vs 1.71 ± 0.9 mmol/l; p = 0.012). Subgroup analysis showed that patients on sulphonylurea, South Asians and males had a significant reduction in both HBA1c and weight.

CONCLUSION

Patients with Type 2 diabetes who fast during Ramadan show an improvement in glycaemic control and diastolic blood pressure, but a worsening of total cholesterol and triglycerides, particularly those of South Asian origin and men.

Diabetes and Ramadan: A concise and practical update

Despite the fact that the month of Ramadan includes 29–30 days and the duration of fasting for each day can last for between 12 and 16 h, it was estimated that a large number of individuals with diabetes do fast during Ramadan. In light of recent advancement of new pharmacological agents, drugs such as vildagliptin, sitagliptin, and liraglutide were found to be safe to use during this month of fasting. These therapeutic agents can also be used in combination with metformin. The use of sulfonylureas, in most of the recent guidelines about diabetes and Ramadan, seems not to gain much support due to the risk of hypoglycemia. In this review, we also addressed the use of insulin injection, insulin pump, and education before, during, and after Ramadan. Further research is needed to determine (i) the therapeutic benefit of new antidiabetic agents and (ii) the benefit of new technologies for the treatment of diabetes.

Safety and metabolic impact of Ramadan fasting in children and adolescents with type 1 diabetes

BACKGROUND

Annually, many children and adolescents with type 1 diabetes mellitus (T1DM) insist on fasting for Ramadan despite being exempted and despite knowing all the risks. We aimed to assess the safety and metabolic impact of Ramadan fasting in children with T1DM using different insulin regimens.

METHODS

Children with T1DM who choose to fast during Ramadan 1434/2013 (29 days) were recruited 3 months before Ramadan. They received pre-Ramadan intensive education. Three insulin regimens were included; Regimen-I (regular insulin/NPH); Regimen-II (regular insulin/insulin glargine) and Regimen-III (premixed insulin). Changes in weight, insulin dose, HbA1c, fructosamine and lipid profile were evaluated.

RESULTS

Out of total 53 patients (24 male), 28 patients (52.8%) completed Ramadan fasting (fasting group). The remaining 25 patients were included in (broke-fasting group). Positive correlation between fructosamine changes and number of days fasted during Ramadan. Significant decrease in post-Ramadan fructosamine (<0.001) and increase in post-Ramadan total cholesterol and low density lipoprotein (LDL) levels were detected within fasting, broke-fasting and insulin regimen groups. Significant higher blood glucose at three time points, pre-Iftar, pre-Sohur and midday in Regimen-I compared to Regimen-II and Regimen-III (p=0.004).

CONCLUSIONS

Fasting during Ramadan is feasible and is associated with significant improvement in fructosamine level in children with T1DM using different insulin regimens. Mandatory consideration to the quality and quantity of food offered to patients with T1DM during Ramadan to guard against adverse changes in lipid profile.