Biochemical, physiological and body composition changes in patients with type 2 diabetes during Ramadan fasting

Abstract

Context: During the month of Ramadan, healthy Muslims must fast from dawn until sunset. However, religious rulings dispense the sick from this duty. During the fast, diabetic patients, are predisposed because of their disease, to an increased risk of hypoglycemia, loss of diabetes control, dehydration especially in summer and thromboembolic complications. Objectives: In order to better categorize the indications for the fasting of the month of Ramadan by people with type 2 diabetes mellitus (T2DM), we studied the effects of fasting on clinical; and biological parameters, dietary behavior, and physical activity. Subjects and Methods: We conducted an observational, descriptive, comparative study of patients with T2DM and 16 age- and sex-matched controls. Results: The average age of patients was 52 ± 4 years, and the mean duration of diabetes was 7 ± 4 years. The fasting did not seem to affect the anthropometric parameters and the glycemic control. For the lipid profile, fasting significantly increased high-density lipoprotein-cholesterol (P = 0.004), total cholesterol (P = 0.001) and triglycerides (P = 0.04). Dietary intake decreased from 54% before Ramadan to 47% in Ramadan (P = 0.001), and the intake of lipids increased from 27% to 37% during Ramadan (P = 0.001), in particular, the intake of polyunsaturated fatty acids, which doubled between the two periods (P = 0.009). Physical activity also showed a significant increase in patients and controls combined, essentially represented by the prayer of Tarawih. Conclusions: The Ramadan fast is well tolerated by T2DM patients, treated by diet or oral antidiabetic medications. They can stay free from serious complications, through regular medical support and self-monitoring. However, it is necessary for patients allowed to fast by their physician, to ensure a proper nutrition and obtain diabetes education.