Effect of ramadan fasting on microvascular complications in type1 diabetic patients

Abstract

Abstract Background Diabetes is a complex, chronic illness requiring continuous medical care with multifactorial risk-reduction strategies beyond glycemic control. Ongoing patient self-management education and support are critical to preventing acute complications and reducing the risk of long-term complications. Significant evidence exists that supports a range of interventions to improve diabetes outcomes. Objective This study aimed to demonstrate the impact of fasting on primarily on ẻGFR & microalbuminuria in people with type 1 diabetes and secondarily on neuropathy & retinopathy. It was conducted on 60 patients with T1DM. All patients underwent full history taking, full clinical examination and biochemical tests including FBG, 2h PPBG, HbA1c, fructosamine, s.creatinine, BUN, uACR, eGFR, fundus examination and DN4 Q. Methods This study was conducted on 60 type 1 diabetic patients with microalbuminuria intending to fast Ramadan. Patients were recruited from internal medicine and diabetes clinics of Ain Shams University. The study performed health education 2 months prior to Ramadan 1438 (2017) with follow up throughout the month and after Ramadan. The patients were on basal-bolus regimen, 36 were on lantus, 17 were on NPH and the remaining 7 patients didnot complete the follow up after Ramadan for family reasons. Results There had been significant difference between pre and post-fasting as regards weight and BMI, and non significant difference regards waist circumference. Also highly significant difference between basal and bolus doses before and during Ramadan. There had been no significant difference between pre and post Ramadan regarding fundus examination, systolic and diastolic blood pressure and a significant difference regarding DN4 Q. Regarding no. of successful fasting days and attacks of hypoglycemia, a significant difference was found. Significant difference in FBS, 2hr PPBG, BUN, s.creatinine, uACR and eGFR, and fructosamine. There was a significant positive correlation between eGFR and height, weight before Ramadan and between eGFR and height, weight after Ramadan, no. of successful fasting days Ramadan 2017. Also a significant negative correlation was shown between eGFR and A / C ratio, Cr, BUN before Ramadan and between éGFR and Cr, BUN after Ramadan. Height, BUN before and after Ramadan and A / C ratio before Ramadan were found to be independent predictors of eGFR. Conclusion Ramadan fasting appears to have significant impact on microvascular complications of type 1 DM patients. These impacts can be attributed to many factors as physical sloth, change of time and pattern of feeding, climate conditions at time of fasting especially hot humid weather predisposing to more frequent dehydration with its sequelae as well as non-compliance of some patients to the proper lifestyle, diet and medications.