Vol 10, No 2 (2021)
Research paper
Published online: 2021-05-26
Study of the metabolic effects of Ramadan fasting on patients with type 2 diabetes. Relation to glycemic control, hypoglycemic events and diabetic complications
Clin Diabetol 2021;10(2):161-168.
Abstract
Background. The aim of this study is to evaluate the metabolic effects of Ramadan fasting on patients with type 2 diabetes, and their relation to glycemic control, risk of hypoglycemia, as well as any possible effects on diabetic complications.
Methods. 300 subjects with type 2 diabetes were assessed to evaluate the metabolic effects of Ramadan fasting regarding glycemic control, risk of hypoglycemia and any possible effects on diabetic complications. The examination included measurement of body mass index (BMI), blood pressure, examination of the foot for sensory loss and peripheral vascular disease (PVD) by assessing the vibration sense and calculating the ankle-brachial index (ABI) respectively. Laboratory tests included fasting plasma glucose (FPG), HbA1c, complete lipid profile, serum creatinine, urinary albumin-to-creatinine ratio (UACR) and calculation of eGFR.
Results. BMI, blood pressure, FPG, and triglycerides levels were lower in patients after Ramadan compared to their levels before Ramadan, while eGFR was higher after Ramadan than it was before Ramadan. Hypo-glycemia was highest in patients treated with insulin followed by those treated with oral agents including sulfonylureas as compared to oral agents excluding sulfonylureas (p = 0.002).
Conclusion. Fasting during Ramadan can affect body weight, blood pressure, glycemic parameters and the frequency of acute glycemic complications in patients with type 2 diabetes. Hypoglycemia was highest in patients treated with insulin followed by those treated with oral agents especially sulfonylureas.
Keywords: fastingtype 2 diabetesglycemic controlrisk of hypoglycemia
References
- Bashir MI, Pathan MdF, Raza SA, et al. Role of oral hypoglycemic agents in the management of type 2 diabetes mellitus during Ramadan. Indian J Endocrinol Metab. 2012; 16(4): 503–507.
- Salti I, Bénard E, Detournay B, et al. A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diabetes Care. 2004; 27(10): 2306–2311.
- Mans KS. Study the effects of Ramadan fasting on the serum glucose and lipid profile among healthy jordanian students. American Journal of Applied Sciences. 2007; 4(8): 565–569.
- M'guil M, Ragala MA, El Guessabi L, et al. Is Ramadan fasting safe in type 2 diabetic patients in view of the lack of significant effect of fasting on clinical and biochemical parameters, blood pressure, and glycemic control? Clin Exp Hypertens. 2008; 30(5): 339–357.
- Benaji B, Mounib N, Roky R, et al. Diabetes and Ramadan: review of the literature. Diabetes Res Clin Pract. 2006; 73(2): 117–125.
- Vasan SK, Karol R, Mahendri NV, et al. A prospective assessment of dietary patterns in Muslim subjects with type 2 diabetes who undertake fasting during Ramadan. Indian J Endocrinol Metab. 2012; 16(4): 552–557.
- Khaled BM, Belbraouet S. Effect of Ramadan fasting on anthropometric parameters and food consumption in 276 type 2 diabetic obese women. Int J Diabetes Dev Ctries. 2009; 29(2): 62–68.
- Pinelli NR, Jaber LA. Practices of Arab American patients with type 2 diabetes mellitus during Ramadan. J Pharm Pract. 2011; 24(2): 211–215.
- Ziaee V, Razaei M, Ahmadinejad Z, et al. The changes of metabolic profile and weight during Ramadan fasting. Singapore Med J. 2006; 47(5): 409–414.
- Al-Arouj M, Assaad-Khalil S, Buse J, et al. Recommendations for management of diabetes during Ramadan: update 2010. Diabetes Care. 2010; 33(8): 1895–1902.
- Cryer PE, Davis SN, Shamoon H. Hypoglycemia in diabetes. Diabetes Care. 2003; 26(6): 1902–1912.
- Almaatouq MA. Pharmacological approaches to the management of type 2 diabetes in fasting adults during Ramadan. Diabetes Metab Syndr Obes. 2012; 5: 109–119.
- Bonakdaran SH, Khajeh-Dalouie M. The effects of fasting during Ramadan on glycemic excursions detected by continuous glucose monitoring system (CGMS) in patients with type 2 diabetes. Med J Malaysia. 2011; 66(5): 447–450.
- Armstrong DG, Lavery LA, Vela SA, et al. Choosing a practical screening instrument to identify patients at risk for diabetic foot ulceration. Arch Intern Med. 1998; 158(3): 289–292.
- Boulton AJM, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment. A report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Phys Ther. 2008; 88(11): 1436–1443.
- Cowie CC, Rust KF, Byrd-Holt DD, et al. Prevalence of diabetes and high risk for diabetes using A1C criteria in the U.S. population in 1988-2006. Diabetes Care. 2010; 33(3): 562–568.
- Shepherd J, Barter P, Carmena R, et al. Effect of lowering LDL cholesterol substantially below currently recommended levels in patients with coronary heart disease and diabetes: the Treating to New Targets (TNT) study. Diabetes Care. 2006; 29(6): 1220–1226.
- Eknoyan G, Lameire N, Eckardt K, et al. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2013; 3(1): 5–14.
- Hassanein M, Al-Arouj M, Hamdy O, et al. International Diabetes Federation (IDF), in collaboration with the Diabetes and Ramadan (DAR) International Alliance. Diabetes and Ramadan: Practical guidelines. Diabetes Res Clin Pract. 2017; 126: 303–316.
- International Hypoglycaemia Study Group. Glucose concentrations of less than 3.0 mmol/l (54 mg/dl) should be reported in clinical trials: a joint position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2017; 60(1): 3–6.
- Jaleel MA, Raza SA, Fathima FN, et al. Ramadan and diabetes: As-Saum (The fasting). Indian J Endocrinol Metab. 2011; 15(4): 268–273.
- Jabbar A, Hassanein M, Beshyah SA, et al. CREED study: Hypoglycaemia during Ramadan in individuals with Type 2 diabetes mellitus from three continents. Diabetes Res Clin Pract. 2017; 132: 19–26.
- Khaled M, Belbraouet S. Ramadan fasting diet entailed a lipid metabolic disorder among type 2 diabetic obese women. American Journal of Applied Sciences. 2009; 6(3): 471–477.
- Hassanein M. Ramadan focused diabetes education; a much needed approach. J Pak Med Assoc. 2015; 65(5 Suppl 1): S76–S78.
- Sfar H, Sellami S, Boukhayatia F, et al. Biochemical, physiological and body composition changes in patients with type 2 diabetes during Ramadan fasting. Ibnosina Journal of Medicine and Biomedical Sciences. 2017; 9(6): 164–168.
- Tiboura G, Khaled B, Diaf M, et al. Effect of Ramadan Fasting on Serum Glucose and Lipid Profile Among Algerian Type 2 Diabetes Patients. Romanian Journal of Diabetes Nutrition and Metabolic Diseases. 2015; 22(4): 385–392.
- Bener A, A Al-Hamaq AOA, Öztürk M, et al. Effect of ramadan fasting on glycemic control and other essential variables in diabetic patients. Ann Afr Med. 2018; 17(4): 196–202.
- Sahin SB, Ayaz T, Ozyurt N, et al. The impact of fasting during Ramadan on the glycemic control of patients with type 2 diabetes mellitus. Exp Clin Endocrinol Diabetes. 2013; 121(9): 531–534.
- Mushtaq R, Akram A, Mushtaq R, et al. Effect of Ramadan fasting on serum insulin and fasting blood glucose in adult obese and overweight population of karachi, pakistan. FUUAST Journal of Biology. 2018; 8(1): 139–149.
- Bragazzi NL. Ramadan fasting and chronic kidney disease: does estimated glomerular filtration rate change after and before Ramadan? Insights from a mini meta-analysis. Int J Nephrol Renovasc Dis. 2015; 8: 53–57.
- Hassan S, Hassan F, Abbas N, et al. Does Ramadan fasting affect hydration status and kidney function in CKD patients? Ann Nutr Metab. 2018; 72(3): 241–247.
- Bakhit AA, Kurdi AM, Wadera JJ, et al. Effects of Ramadan fasting on moderate to severe chronic kidney disease. A prospective observational study. Saudi Med J. 2017; 38(1): 48–52.
- Pathan M, Patil R. Effect of Ramadan fasting on body weight and lipid profile. Biomedical and Pharmacology Journal. 2015; 3(1): 167–170.
- Elmehdawi RR, Mukhtad NA, Allaghi NI, et al. Fasting of Ramadan in peoples with diabetes in Benghazi, Libya: an exploratory study. Libyan J Med. 2010; 5.
- Ba-Essa EM, Hassanein M, Abdulrhman S, et al. Attitude and safety of patients with diabetes observing the Ramadan fast. Diabetes Res Clin Pract. 2019; 152: 177–182.
- Bott S, Shafagoj YA, Sawicki PT, et al. Impact of smoking on the metabolic action of subcutaneous regular insulin in type 2 diabetic patients. Horm Metab Res. 2005; 37(7): 445–449.
- Feldman-Billard S, Massin P, Meas T, et al. Hypoglycemia-induced blood pressure elevation in patients with diabetes. Arch Intern Med. 2010; 170(9): 829–831.
- Yun JS, Park YM, Han K, et al. Presence of macroalbuminuria predicts severe hypoglycemia in patients with type 2 diabetes: a 10-year follow-up study. Diabetes Care. 2013; 36(5): 1283–1289.
- Frier BM, Schernthaner G, Heller SR. Hypoglycemia and cardiovascular risks. Diabetes Care. 2011; 34 Suppl 2: S132–S137.
- Tsujino D, Nishimura R, Onda Y, et al. The relationship between HbA1c values and the occurrence of hypoglycemia as assessed by continuous glucose monitoring in patients with type 1 diabetes. Diabetol Metab Syndr. 2016; 8: 53.
- Li Y, Mu Y, Ji Q, et al. Hypoglycaemia, Abnormal Lipids, and Cardiovascular Disease among Chinese with Type 2 Diabetes. Biomed Res Int. 2015; 2015: 862896.