Comparison of Structured Nutrition Therapy for Ramadan with Standard Care in Type 2 Diabetes Patients

Abstract

1) Background: Structured nutrition therapy (NT) is essential for the management of type 2 diabetes (T2D), but the optimal delivery during Ramadan fasting remains unclear. The present study aimed to evaluate the effect of structured NT program versus standard care in patients with T2D during Ramadan.(2) Methods: The present study was an 8-week, parallel, non-randomized study with patients' preference design involving 64 patients with T2D. The participants were asked to choose their preferred group, i.e., structured NT (Structured Ramadan NT, sRNT) or standard care (SC). The participants in the sRNT group received a Ramadan-focused nutrition plan, including a diabetes-specific formula throughout the study, whereas the patients in the SC group received standard nutrition care. Study outcomes included clinical outcomes and quality of life (QoL). Data was analyzed using two-way repeated-measures ANOVA and linear mixed-effects model. (3) Results: More than half of the participants (n = 38, 63%) chose sRNT as their preferred group. Both groups had comparable baseline characteristics. After 8-weeks of the respective intervention, participants in the sRNT group had lower levels of fasting plasma glucose (−0.9 ± 0.3 mmol/L vs. 0.2 ± 0.3 mmol/L, p < 0.05), triglycerides (−0.21 ± 0.08 mmol/L vs. 0.20 ± 0.17 mmol/L, p < 0.05), and self-monitoring glucose at pre-dawn (6.9 mmol/L vs. 7.8 mmol/L, p < 0.05) and pre-bedtime (7.6 mmol/L vs. 8.6 mmol/L, p < 0.05) than participants in the SC group. Although not different between groups, HbA1c levels decreased significantly in the sRNT (−0.72 ± 0.16%, p < 0.001) but not in the SC group (−0.35 ± 0.24%, p = 0.155). QoL and satisfaction scores improved significantly in sRNT group, but not in SC group.(4) Conclusions: The structured NT regimen for Ramadan is a feasible and beneficial program for T2D patients observing Ramadan fasting as it showed an improvement in clinical outcomes and QoL.

Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

“…An overall healthy eating plan that results in an energy deficit, in conjunction with medications and/or metabolic surgery as individually appropriate, should be considered to support glycaemic and weight management goals in adults with type 2 diabetes [ 5 , 22 ]. Structured nutrition and lifestyle programmes may be considered for glycaemic benefit and can be adapted for specific cultural indications [ 83 – 87 ].…”

How quality of life is measured in studies of nutritional intervention: a systematic review

“…This instrument has been used in numerous studies in both type I DM and type 2 DM patients. [ 167 ] 1 [ 168 ] SWAL-QOL Dysphagia SWAL-QOL, a disease-specific measure of quality of life and quality of care for patients with oropharyngeal dysphagia. It assesses 10 QoL concepts; eight of which are dysphagia-related QoL (food selection, burden, mental health, social functioning, fear, eating duration, eating desire, communication) and two pertaining to general QoL (sleep and fatigue).…”

Ramadan-specific nutrition education improves cardio-metabolic health and inflammation—a prospective nutrition intervention study from Pakistan

“…Favorable questions (1-5) were scored as follows: 1 = strongly disagree, 2 = disagree, 3 = agree, and 4 = strongly agree. For unfavorable questions (6)(7)(8)(9)(10)(11)(12)(13), this scoring was reversed as follows: 1 = strongly agree, 2 = agree, 3 = disagree, and 4 = strongly disagree. The questionnaire was completed before the intervention (baseline T1) and at the end of the intervention (i.e., at the end of Ramadan fasting, T2).…”

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