Evaluating the Effect of Ramadan Fasting on Muslim Patients with Diabetes in relation to Use of Medication and Lifestyle Patterns: A Prospective Study

Melanie Yee Lee Siaw, Daniel Ek Kwang Chew, Rinkoo Dalan, Shaikh Abdul Kader Kamaldeen Abdul Shakoor, Noorani Othman, Chor Hui Choo, Nur Hidayah Shamsuri, Siti Nurhana Abdul Karim, Sui Yung Chan, Joyce Yu-Chia Lee, Melanie Yee Lee Siaw, Daniel Ek Kwang Chew, Rinkoo Dalan, Shaikh Abdul Kader Kamaldeen Abdul Shakoor, Noorani Othman, Chor Hui Choo, Nur Hidayah Shamsuri, Siti Nurhana Abdul Karim, Sui Yung Chan, Joyce Yu-Chia Lee

Abstract

Objectives. This study aimed to examine the effect of Ramadan fasting on HbA1c in Muslim patients with type 2 diabetes. The incidence of hypoglycemia and glycemic changes in relation to the adjustment of doses of antidiabetic agents, diet, and physical activity during Ramadan was also evaluated. Methods. This was a prospective study conducted in an outpatient endocrine clinic. A set of questionnaires was administered to Muslim patients with diabetes who fasted for ≥10 days. Those who were hospitalized for diabetic ketoacidosis or severe hypoglycemia a month prior to Ramadan or were given short-term corticosteroid therapy were excluded. The patients' responses and clinical outcomes from the clinic database were collected before, during, and after Ramadan. Results. A total of 153 participants completed the study. The mean HbA1c improved from 8.9% before Ramadan to 8.6% during Ramadan (P < 0.05). Although diet and physical activity did not contribute to changes in glycemia, a significant improvement in HbA1c was observed in patients who had adjustments made to their doses of antidiabetic agents during Ramadan (P < 0.001). In addition, their rate of hypoglycemia was minimal. Conclusions. Ramadan fasting appeared to improve glycemic control, especially in those whose doses of antidiabetic agents were adjusted during Ramadan.

Figures

Figure 1
Figure 1
Trends of change in mean HbA1c.
Figure 2
Figure 2
Trends of change in mean HbA1c in relation to adjustment of the dose of antidiabetic agents.

References

    1. Bashir M. I., Pathan M. F., Raza S. A., et al. Role of oral hypoglycemic agents in the management of type 2 diabetes mellitus during Ramadan. Indian Journal of Endocrinology and Metabolism. 2012;16(4):503–507. doi: 10.4103/2230-8210.97994.
    1. Salti I., Bénard E., Detournay B., Bianchi-Biscay M., le Brigand C., Voinet C., Jabbar A. 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. doi: 10.2337/diacare.27.10.2306.
    1. Mansi K. M. S. 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. doi: 10.3844/ajassp.2007.565.569.
    1. M'Guil M., Ragala M. A., El Guessabi L., Fellat S., Chraibi A., Chebraoui L., Israili Z. H., Lyoussi B. 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? Clinical and Experimental Hypertension. 2008;30(5):339–357. doi: 10.1080/10641960802272442.
    1. Benaji B., Mounib N., Roky R., Aadil N., Houti I. E., Moussamih S., Maliki S., Gressier B., El Ghomari H. Diabetes and Ramadan: review of the literature. Diabetes Research and Clinical Practice. 2006;73(2):117–125. doi: 10.1016/j.diabres.2005.10.028.
    1. Vasan S. K., Karol R., Mahendri N. V., Arulappan N., Jacob J. J., Thomas N. A prospective assessment of dietary patterns in Muslim subjects with type 2 diabetes who undertake fasting during Ramadan. Indian Journal of Endocrinology and Metabolism. 2012;16(4):552–557. doi: 10.4103/2230-8210.98009.
    1. Khaled B. M., Belbraouet S. Effect of Ramadan fasting on anthropometric parameters and food consumption in 276 type 2 diabetic obese women. International Journal of Diabetes in Developing Countries. 2009;29(2):62–68. doi: 10.4103/0973-3930.53122.
    1. Pinelli N. R., Jaber L. A. Practices of Arab American patients with type 2 diabetes mellitus during Ramadan. Journal of Pharmacy Practice. 2011;24(2):211–215. doi: 10.1177/0897190010367432.
    1. Ziaee V., Razaei M., Ahmadinejad Z., Shaikh H., Yousefi R., Yarmohammadi L., Bozorgi F., Behjati M. J. The changes of metabolic profile and weight during Ramadan fasting. Singapore Medical Journal. 2006;47(5):409–414.
    1. Al-Arouj M., Assaad-Khalil S., Buse J., Fahdil I., Fahmy M., Hafez S., Hassanein M., Ibrahim M. A., Kendall D., Kishawi S., Al-Madani A., Nakhi A. B., Tayeb K., Thomas A. Recommendations for management of diabetes during Ramadan: update 2010. Diabetes Care. 2010;33(8):1895–1902. doi: 10.2337/dc10-0896.
    1. Cryer P. E., Davis S. N., Shamoon H. Hypoglycemia in diabetes. Diabetes Care. 2003;26(6):1902–1912. doi: 10.2337/diacare.26.6.1902.
    1. Almaatouq M. A. Pharmacological approaches to the management of type 2 diabetes in fasting adults during Ramadan. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2012;5:109–119. doi: 10.2147/DMSO.S23261.
    1. Bonakdaran S. H., 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. Medical Journal of Malaysia. 2011;66(5):447–450.
    1. Singapore Census of Population Census of population 2010 statistical release 1: education, language and religion. Department of Statistics, Ministry of Trade and Industry, Singapore, 2010, .
    1. Hari Raya Aidilfitri. Singapore Tourism, 2014, .
    1. Norouzy A., Mohajeri S. M. R., Shakeri S., Yari F., Sabery M., Philippou E., Varasteh A.-R., Nematy M. Effect of Ramadan fasting on glycemic control in patients with type 2 diabetes. Journal of Endocrinological Investigation. 2012;35(8):766–771. doi: 10.3275/8015.
    1. Khatib F. A., Shafagoj Y. A. Metabolic alterations as a result of Ramadan fasting in non-insulin-dependent diabetes mellitus patients in relation to food intake. Saudi Medical Journal. 2004;25(12):1858–1863.
    1. Lee J. Y.-C., Tsou K., Lim J., Koh F., Ong S., Wong S. ‘Symptom-based Insulin adjustment for Glucose Normalization’ (SIGN) algorithm: a pilot study. Diabetes Technology & Therapeutics. 2012;14(12):1145–1148. doi: 10.1089/dia.2012.0140.
    1. Dipiro J. T., Talbert R. L., Yee G. C., Matzke G. R., Wells B. G., Posey L. M. Pharmacotherapy: A Pathophysiologic Approach. New York, NY, USA: McGraw-Hill; 2008.
    1. British National Formulary. BMJ Group and Pharmaceutical Press; 2014.
    1. Miller C. D., Phillips L. S., Ziemer D. C., Gallina D. L., Cook C. B., El-Kebbi I. M. Hypoglycemia in patients with type 2 diabetes mellitus. Archives of Internal Medicine. 2001;161(13):1653–1659. doi: 10.1001/archinte.161.13.1653.
    1. Mafauzy M. Repaglinide versus glibenclamide treatment of type 2 diabetes during Ramadan fasting. Diabetes Research and Clinical Practice. 2002;58(1):45–53. doi: 10.1016/S0168-8227(02)00104-3.
    1. Hui E., Bravis V., Salih S., Hassanein M., Devendra D. Comparison of Humalog Mix 50 with human insulin Mix 30 in type 2 diabetes patients during Ramadan. International Journal of Clinical Practice. 2010;64(8):1095–1099. doi: 10.1111/j.1742-1241.2010.02347.x.
    1. Haouari-Oukerro F., Ben-Attia M., Kaâbachi N., Haouari M. Ramadan fasting influences on food intake consumption, sleep schedule, body weight and some plasma parameters in healthy fasting volunteers. African Journal of Biotechnology. 2013;12(21):3327–3332. doi: 10.5897/AJB11.635.
    1. Abdulrahman M. A., Manssor A. J., Marbut M. M. The effect of Ramadan fasting & moderate exercise on body weight, serum glucose & lipid profile in healthy fasting subjects. Medical Journal of Tikrit. 2006;2(122):26–30.
    1. Khan N., Khan M. H., Zaman Shaikh M., Khanani M. R., Rasheed A. Effects of Ramadan fasting and physical activity on glucose levels and serum lipid profile among type 2 diabetic patients. Pakistan Journal of Medical Sciences. 2012;28(1):91–96.
    1. Ruelas V., Roybal G. M., Lu Y., Goldman D., Peters A. Clinical and behavioral correlates of achieving and maintaining glycemic targets in an underserved population with type 2 diabetes. Diabetes Care. 2009;32(1):54–56. doi: 10.2337/dc08-1234.
    1. van Bastelaar K. M. P., Pouwer F., Cuijpers P., Riper H., Snoek F. J. Web-based depression treatment for type 1 and type 2 diabetic patients: a randomized, controlled trial. Diabetes Care. 2011;34(2):320–325. doi: 10.2337/dc10-1248.
    1. Diehl A. K., Sugarek N. J., Bauer R. L. Medication compliance in non-insulin-dependent diabetes: a randomized comparison of chlorpropamide and insulin. Diabetes Care. 1985;8(3):219–223. doi: 10.2337/diacare.8.3.219.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit