Optimizing Ramadan fasting: A randomised controlled trial for people with type 2 diabetes during Ramadan applying the principles of the ADA/EASD consensus

Abstract

Background Fasting during the holy month of Ramadan is one of the five pillars of Islam. Fasting is not meant to create excessive hardship on the Muslim individual according to religious tenets. It is important that health professionals are aware of potential risks associated with fasting during the month of Ramadan (mainly hypoglycemia and hyperglycemia). Aims To explore the impact of applying the principles of our 2020 recommendations for the management of type 2 diabetes (T2D) during the month of Ramadan. Methods A multinational randomized controlled trial (RCT) was conducted in five Muslim majority countries. Six hundred and sixty participants were deemed eligible for the study; however, 23% declined to participate later for various reasons. In total, 506 participants were enroled and were equally randomized to the intervention or the control group. At the end of the study, data from 231 participants in the intervention group and 221 participants from the control group were collected after 12.6% and 8.7% were, respectively, lost to follow‐up. Participants were randomized to receive a Ramadan‐focussed education with treatment for diabetes adjusted as per our 2020 recommendation update compared with the local usual care (control group). Results are presented using mean, standard deviation, odds ratio (OR), and percentages. Results At the end of the study, the number of hypoglycemic episodes in the intervention group was less than in participants who received usual care. The intervention group had significantly lower severe hypoglycemia compared to the control group with an OR of 0.2 [0.1–0.8]. Compared to baseline, both groups had a significant reduction in glycated haemoglobin (HbA1c), but the improvements were significantly greater in the intervention group. Whilst body weight reduced and high‐density lipoprotein cholesterol increased with the intervention, these changes were not significantly different from usual care. Conclusions A pre‐Ramadan assessment of people with T2D coupled with pre‐Ramadan education and an adjustment of glucose‐lowering treatment as per our updated 2020 recommendations can prevent acute complications and allow a safer fast for people with T2D. We have shown that such an approach reduces the risk of developing severe hypoglycemia and improves the metabolic outcomes in people with T2D.

First-time Usage of SGLT2 Inhibitors in Patients with Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety

“…Indeed, the majority of Muslims with diabetes continue to fast despite medical advice to the contrary [11,12] . However, there are signi cant hazards that fasting may entail [13] .…”

Diabetes and Ramadan Fasting (2023): The Year in Review

“…A previous study analyzed the impact of applying recommendations from the American Diabetes Association and the European Association for the Study of Diabetes (ADA/EASD) on management of T2D during Ramadan. 19 A multinational, randomized controlled trial (RCT) was conducted in five Muslim-majority countries. Six hundred and sixty participants were approached.…”

Precision Medicine in Type 2 Diabetes Mellitus: Utility and Limitations

“…As a result, it has been observed that people observing a period of pre-Ramadan assessment with clinicians, as a personalized approach, could improve metabolic balance and also prevent acute complications during and after Ramadan period. 99,100 Nutrigenetics studies the role of genetic variants in the modulation of response to diet and the implications in the development, or prevention, of diseases. In particular, some genetic variants seem associated with diet response for what concerns the development of cardiovascular diseases, mainly obesity and diabetes.…”