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Ramadan Fasting and Type 2 Diabetes

Fasting found to lead to deterioration of glycemic control in people with type 2 diabetes.

Ramadan is the ninth month of the Islamic calendar and takes place once a year. Muslims all over the world observe this month as a month of fasting to commemorate the first revelation of the Quran to the prophet Muhammad. Fasting requires abstinence from any food, drink, and smoking from sunrise to sunset. Although patients with type 2 diabetes are exempt from fasting during Ramadan, most individuals still fast. People with type 2 diabetes who do fast increase their risk of developing hypo- and hyperglycemic episodes. This raises concerns as to whether fasting during Ramadan is safe for individuals with diabetes. This article observes studies determining whether fasting during Ramadan affects glycemic control in people with type 2.

During the holy month of Ramadan, individuals consume traditional foods that are high in carbohydrates, fats, and protein. Past studies have shown that foods consumed during Ramadan pose a risk of hyperglycemia among people with diabetes. Moreover, reports of low energy levels during Ramadan were observed among those fasting who have diabetes. In addition, repetitive dietary and sleep changes during Ramadan may induce changes in hormones, which regulate energy metabolism. In healthy adults, intermittent fasting caused an increase in insulin-mediated glucose uptake. Furthermore, studies have suggested that although Ramadan fasting does not affect glycemic control in people with diabetes who have well-controlled glucose levels, it is still imperative that those individuals who elect to fast check their blood glucose levels several times a day to prevent hypo- or hyperglycemic episodes.

In the study titled “Effects of Ramadan fasting on glycemic control in patients with type 2 diabetes,” researchers aim to study the effects of fasting on blood glucose control in individuals with type 2 diabetes. A prospective cohort study was designed incorporating eighty-eight patients with type 2 diabetes from Khorasan Diabetes Society and Ghaem teaching hospital in Mashad, Iran. Of the eighty-eight patients, 45 were male and 43 were female. All patients were between the ages of 50-60 years. The individuals selected had opted to fast for at least 10 days during the month of Ramadan. People with diabetes who were on oral hypoglycemic drugs (OHD) were required to take their medications at sunrise and again at sunset if they had a twice-daily regimen. Those with a three-time daily regimen were required to take their medications at sunrise, sunset and midnight. Patients were also required to attend the metabolic unit at three separate periods 1 week before Ramadan, 3 days after Ramadan, and 1 month after Ramadan. Each occasion was observed following a 10-hour overnight fast. During this time, three 6-mL blood samples were taken to assess fasting blood glucose, insulin, hemoglobin A1c (HbA1c), total cholesterol, LDL, HDL, triglycerides and cell blood count. Blood pressure was also measured and comprehensive medical histories were taken. Patients were divided into two groups: those taking OHD (17 on metformin, 10 were on sulfonylureas, and 34 were on both metformin and sulfonylurea) (61 patients total) and those with diet-controlled diabetes (27 patients). Patients were further divided into two groups based on their glycemic control: Group A: HbA1c <7.5%, Group B: HbA1c >7.5%. A paired test was used to compare two sets of normally distributed data and the Wilcoxon Signed Ranks Test was used for non-parametric data. A p-value <0.05 was statistically significant and a power calculation revealed that the sample size had a statistical power of 81%.

Results indicated that among the eighty-eight patients, fasting blood glucose and HbA1c significantly increased (p=0.002 and <0.001 respectively). There was also a significant decrease in insulin concentration (p=0.017). HDL concentration increased (p<0.001) whereas LDL levels, body weight and BMI decreased ((p=0.023, p<0.001, respectively). Although HbA1c increased, there was no significant change between HbA1c 1 week before Ramadan and 1 month after Ramadan. With respect to glycemic control, there was a significant increase in HbA1c between those with poorly controlled and well-controlled diabetes (P=0.016, p<0.001, respectively). In addition, the effect of Ramadan fasting on glycemic control in patients using OHD versus those with diet-controlled diabetes showed deterioration in HbA1c except for patients using sulfonylureas. In addition, there was an increase in fasting blood glucose only in patients using both metformin and sulfonylureas. BMI declined with the number of fasting days (p=0.004).

Researchers concluded that fasting had a negative effect on HbA1c levels and fasting blood glucose primarily among patients using OHD. This increase in HbA1c and fasting blood glucose levels could be in part due to the type of foods consumed during Ramadan. The consumption of excessive carbohydrates, fats, and protein can greatly impact one’s HbA1c and fasting blood glucose levels. Moreover, the changes in the time that one takes his/her OHD medication may also impact the deterioration in glycemic control.

Practice Pearls:

  • Ramadan is a time in which Muslims all over the world fast from sunrise to sunset for 30 days.
  • There is a link between fasting and glycemic control among people with type 2 diabetes.
  • Fasting during Ramadan leads to deterioration in HbA1c among people with diabetes.

Malik, Uzma, Nasir Mahmood, Khurshid Ahmed Khan, Maliha Hameed, Fawad Ahmed Randhawa, Sadia Salman, Amna Riaz, Khadija Waheed, and Aqeela Rasheed. “GLYCEMIC CONTROL OF TYPE 2 DIABETIC PATIENTS DURING RAMADAN FASTING.” Journal of Ayub Medical College Abbottabad. N.p., n.d. Web. 19 July 2017.

Nuha Awad, Doctor of Pharmacy Candidate: Class of 2018; LECOM College of Pharmacy