Ramadan Fasting In Patients Research Articles

The challenge of Ramadan fasting in patients with type 1 diabetes mellitus

The challenge of Ramadan fasting in patients with type 1 diabetes mellitus

The use of prednisolone during Ramadan fasting in patients with adrenal insufficiency.

Once daily prednisolone taken at predawn has been proposed to be the glucocorticoid replacement of choice in patients with adrenal insufficiency (AI) who intend to fast for the month of Ramadan. However, the effects of prednisolone on metabolic parameters and quality of life during fasting for Ramadan are unknown. Patients with AI on twice-daily hydrocortisone, who had low or moderate risk and intended to fast, were recruited. Patients were converted to prednisolone 5 mg once daily taken at sahur (predawn) and Ramadan education given. Weight, sleep duration, biochemical parametersand quality of life measures (SF-36 questionnaire) were analysed at the end of Ramadan and compared against baseline. Twenty patients (13 men) were recruited, with a mean age of 59.9 ± 15.0 years. All patients were on hydrocortisone 15 mg daily (in divided doses) as pre-Ramadan glucocorticoid replacement. Half had type 2 diabetes with low IDF-DAR risk. Eighty-five percentof patients completed the full 29 days of fasting with no complications. There was a significant reduction in weight (-1.1 ± 1.6 kg, p = .005), with no significant change in blood pressure or sleep duration. There was a significant increase in urea (0.80 ± 1.1 mmol/L, p = .005) and haematocrit, (0.011 ± 0.019 L/L, p = .019) and decrease in serum sodium (-1.6 ± 3.0 mmol/L, p = .028), with no change in serum creatinine or liver function. Quality of life measures were preserved in all domains with significant improvement in role limitation due to physical health (15.3 ± 21.6, p = .005) and bodily pain (8.8 ± 16.3, p = .031). This study has demonstrated that converting patients with AI who are fasting for Ramadan from twice-daily hydrocortisone to prednisolone 5 mg daily at sahur was safe, with no major short-term adverse effects. Despite the higher equivalent glucocorticoid doses, patients experienced weight loss and no clinically significant change in blood pressure, sleep, biochemical parameters or quality of life. This study paves the way to trial even lower doses of prednisolone once daily in patients fasting for Ramadan with AI.

Validation of the new IDF-DAR risk assessment tool for Ramadan fasting in patients with diabetes

BackgroundA new IDF-DAR (International Diabetes Federation - Diabetes and Ramadan Alliance) risk stratification tool was published in 2021 to better stratify the risk of Ramadan fasting in people with diabetes. MethodsWe performed a prospective, survey-based study before and after Ramadan 1442/2021 to explore the ability of the new IDF-DAR risk stratification tool to predict the probability of fasting and the risk of complications from fasting in people with diabetes. ResultsA pre-Ramadan assessment was completed for 659 patients who intended to fast in Ramadan; 647(98.2%) answered the post-Ramadan follow-up questionnaire. Mean age was 53.5 years and 47.9% were females. 603(91.5%) had type 2 diabetes while 56(8.5%) had type 1 diabetes. Using the IDF-DAR risk criteria at the pre-Ramadan assessment, 339(51.4%) were categorized as low-risk (score <3), 173(26.3%) as moderate-risk (score 3.5–6) and 147(22.3%) as high-risk (score >6). 94.3%, 81.1% and 76.9% patients fasted the full 30 days in the low, moderate and high risk groups respectively (p < 0.0001). Any hypoglycaemia was reported in the low, moderate and high risk groups by 6.3%, 21.9% and 35.0% respectively while severe hypoglycaemia was reported by 3(2.1%) patients in the high, 3(1.8%) in the moderate and none(0%) in the low risk groups. Hyperglycaemia (>250 mg/dL) was reported in the low, moderate and high risk groups by 2.7%, 13.0% and 23.8% respectively. ConclusionThe new IDF-DAR risk assessment tool appears to reliably predict both the ability to fast during Ramadan as well as the likelihood of getting hypoglycaemia or hyperglycaemia.

Transient increase in glucose variability during Ramadan fasting in patients with insulin-treated type 2 diabetes: A preliminary study

AimWe aimed to examine the effect of Ramadan fasting on interstitial glucose control and variability before, during, and after Ramadan in type 2 diabetes patients receiving insulin therapy. MethodsParticipants received a flash glucose monitoring (FGM) system one week before Ramadan that was removed on the sixth or seventh day (pre- and early Ramadan periods) of Ramadan and a second FGM system one week before the end of Ramadan that was removed one week after the end of Ramadan (late and post-Ramadan periods). Fasting blood samples were collected during the pre-, early, and late Ramadan study visits and tested for HbA1c, serum creatinine, and plasma glucose levels. ResultsThirty-four patients were prospectively included. The standard deviation and coefficient of variation of glucose concentrations were higher in the early Ramadan period than in the pre-Ramadan period, but did not differ in the late or post-Ramadan periods. Changes in the early Ramadan period were restricted to males and patients aged <55 years. No significant changes were observed in the average glucose level, glucose management indicator, time in range, time in hyperglycemia, or time in hypoglycemia at any time point. ConclusionsRamadan fasting in patients with insulin-treated type 2 diabetes is associated with an initial increase in glucose variability that quickly returned to pre-Ramadan levels. Ramadan fasting was not associated with any significant changes in glycemic control measures.

Abstract #1325274: Ramadan Fasting in Patients With Type 1 Diabetes Mellitus on Insulin Pump Followed Up in a Virtual Diabetes Clinic at King Abdulaziz Medical City, Jeddah

Ramadan is a lunar-based holy month in which Muslims are obligated to fast from before the dawn until sunset. The objective of this study is to assess the efficacy and safety of fasting Ramadan in patients with type 1 diabetes mellitus (T1DM) on insulin pump therapy followed up in a virtual insulin pump clinic.

Ramadan fasting outcome among high-risk patients

BackgroundThere is a growing literature on guidelines regarding Ramadan fasting for chronic kidney disease (CKD) patients. However, most studies only consider the impact of fasting on renal function. This study additionally aims to assess factors influencing Ramadan fasting in patients with CKD.MethodThis is a prospective before and after cohort study. CKD patients were counseled regarding fasting and followed-up post-Ramadan for renal function status, actual fasting behavior, and other relevant outcomes. ResultsOf the 360 patients who attended the pre-Ramadan consultation, 306 were reachable after Ramadan of whom 55.3% were female. Of these 306 67.1% reported that they had fasted, 4.9% had attempted to fast but stopped, and 28% did not fast at all. Of these 74 has a post-fasting kidney test. Of the patients, 68.1% had stage 3A CKD, 21.7% had stage 3B, 7.9% stage 4, and only 2% stage 5. Of those who fasted, 11.1% had a drop in Glomerular Filtration Rate (eGFR) of 20% or more. Those who did not fast (16.7%) presented a similar drop. Conversely, among the few who attempted to fast and had to stop, half showed a drop in eGFR of more than 20%. In linear regression, fasting was not associated with post-Ramadan eGFR, when controlling for age and baseline eGRF. There were 17 (5.6%) significant events, including one death. More significant events occurred among the group who fasted some of Ramadan days, 26.7% of the subjects experienced an adverse event—while 4.7% of the group who did not fast had a significant adverse event compared to 4.4% among those who fasted all Ramadan.ConclusionFasting was not a significant determining factor in renal function deterioration in the study’s population, nor did it have any significant association with adverse events.

Effect of Ramadan fasting in patients with type 2 diabetes mellitus treated with sodium-glucose cotransporter 2 inhibitors: A systematic review and meta-analysis.

ABSTRACTAims/IntroductionSodium–glucose cotransporter 2 inhibitors (SGLT‐2i) improve glycemic control and weight, but might be associated with dehydration, hypotension and ketoacidosis, especially in patients with type 2 diabetes mellitus who fast during Ramadan. This meta‐analysis evaluates the effects of Ramadan fasting on patients with type 2 diabetes mellitus treated with SGLT‐2i.Materials and MethodsA literature search was carried out in PubMed, Embase and the Cochrane Library. Quality assessment was carried out using the ROBINS‐I and Cochrane tools for risk of bias, and analyses were carried out using RevMan version 5.3.ResultsA total of five studies were included in this meta‐analysis. During Ramadan, there was a significant reduction in glycated hemoglobin (P < 0.00001) and diastolic blood pressure (P = 0.006), with a non‐significant trend for a reduction in weight (P = 0.44) and systolic blood pressure (P = 0.67). The number and severity of hypoglycemic episodes was lower in patients with type 2 diabetes mellitus treated with SGLT‐2i compared with sulfonylureas. There was no significant change in estimated glomerular filtration rate, β‐hydroxybutyrate, bicarbonate or anion gap. However, we identified considerable heterogeneity among studies, and a lack of head‐to‐head studies with structured outcome reporting on the risks and benefits of SGLT‐2i during Ramadan.ConclusionsThis systematic review and meta‐analysis shows that patients with type 2 diabetes treated with SGLT2i's during Ramadan have an improvement in HbA1c, less hypoglycemia and no major adverse effects.

Impact of Fasting during Ramadan on Renal Functions in Patients with Chronic Kidney Disease.

Introduction:The impact of Ramadan fasting in patients with chronic kidney disease (CKD) remains less studied and with inconsistent results. In this study, we tried to look at the impact of Ramadan fasting on renal function in patients with CKD.Materials and Methods:In this prospective observational study, we included 28 adult CKD patients. All relevant biochemical parameters including renal function tests were done in the month before Ramadan fasting and within 3 months after Ramadan. Urine output, body weight, and blood pressure were also monitored during Ramadan and after the end of Ramadan for at least 10 days.Results:All the 28 patients (mean age: 46 ± 12 years) included in the study managed to fast for the whole month, and none displayed any new clinical symptoms or signs. The renal function worsened in four (14.28%), and it was significant in those with CKD Stages 4 and 5 (P < 0.003).Conclusion:Stable CKD patients can fast with careful monitoring; however, there is a risk of renal function deterioration in advanced CKD.

Safe Ramadan Fasting in Patients with Type I Diabetes Mellitus

Abstract Background All healthy, adult Muslims are obligated to fast from sunrise to sunset for one lunar month each year. During this time, they have to abstain from food, water, beverages, smoking, oral drugs and sexual intercourse. A large multicentred, epidemiological study in 13 Muslim countries also revealed that 43% of people with Type 1 diabetes and 86% of people with Type 2 diabetes observed the fast during Ramadan. Previously, an education programme in London has attempted to provide advice and support locally to Muslim patients with diabetes, who choose to fast during the month of Ramadan. Objective Safety &amp; efficacy of diabetes health education programs in Ramadan fasting in people with T1DM. Methods The study was conducted on 60 Type 1 diabetic patients intended to fast Ramadan 2017 with average fasting hours 16 hrs. The patients were recruited form the Diabetes outpatient clinic at Ain-Sham University hospitals. All participants (60 subjects) received a basic health education program which was based on Conversational MAP (Living with diabetes). Then participants were subdivided into 2 equal groups each of 30 subjects: Group 1 received Modified IDF health education program for Ramadan fasting. Group 2 received Ramadan Conversational MAPS. Only 29 patients in group 1 and 24 patients in group 2 completed the study, while other 7 patients who attended pre-Ramadan health education sessions but were lost to follow up sessions during and after Ramadan, so they were excluded from the study. Conclusion Health education make Ramadan fasting more safe in those patients with type-I diabetes whatever the method of education. Results Speaking of effect of health education programs on safe Ramadan fasting, glycemic control &amp; less frequent hypoglycemic episodes sһowed significant decrease in FBS before and after Ramadan in both study groups witһ a mean difference in FBS are 24.517 mg/dl and 61.833mg/dl IDF &amp; MAPS groups respectively .

Recommendations for Ramadan fasting to patients with cardiovascular diseases; Turkish Society of Cardiology consensus report

Fasting is one of the important rituals in Islam. According to the Islamic faith, it is an obligation for all Muslims. It is also a common practice in other religions such as Christianity, Judaism, and Hinduism and for philosophies such as Buddhism, Taoism, and Jainism. Each belief or sect has a different type of fasting according to their creed. The fasting period and practice may differ. For example, the Ramadan for Sunni Muslims, Muharram for Alevi Muslims and Lent for Catholics are specific periods for fasting. Ramadan fasting lasts for 29–30 days, Muharram fasting for 10–12 days, and Lent fasting lasts for 40 days. The Ramadan fasting period may vary with the geographic region, but generally it is 12 hours long. It can be as long as 22 hours in the polar regions during summertime (1–4). The practice of fasting in Islam is a mandatory ritual for every healthy individuals, but fasting is be optional for those who are too sick to fast. But what sickness permits breaking the fast is not clear. Therefore, the eligibility or the lack of it to fast is steeped in controversy for some sick people. Particularly in the last 2 decades, numerous studies have been published regarding the effects of religious fasting on general health. More than 1000 articles are available on the PubMed database related to Ramadan and Lent/Biblical fasting. However, there is limited evidence for this topic, and most studies are retrospective with a limited number of patients. Moreover, in general, the quality is poor with limited conclusions to draw suggestions for clinical practice (5, 6). Furthermore, it is impossible to conduct randomized controlled trials on religious fasting to reach more conclusive results. The main objective of the current paper is to summarize the current literature on Ramadan fasting and discuss the potential beneficial or adverse effects on patients with or at risk of cardiovascular disease. The second aim is to propose an evidence-based suggestion regarding who is eligible and not eligible for fasting. Specific highlights and consideration for each patient group are discussed in following sections and summarized in Table 1. Table 1 Consensus statements on Ramadan fasting in patients with cardiovascular diseases

P1587EFFECT OF INTERMITTENT FASTING IN RAMADAN ON BODY COMPOSITION AND NUTRITIONAL PARAMETERS IN PATIENTS ON MAINTENANCE HEMODIALYSIS

Abstract Background and Aims Intermittent fasting has been demonstrated to have many potential health-promoting effects. Intermittent fasting regimens were proven to influence metabolic regulation and chronic inflammation. Fasting during the month of Ramadan can be considered as a model of intermittent fasting among Muslims. In general, there is a shortage of studies in the context of the effect of Ramadan fasting in patients on maintenance hemodialysis (HD). The present study aimed to assess the effects of fasting in Ramadan on body composition as well as nutritional and inflammation parameters in patients on chronic HD. Method This prospective observational study included 68 patients on maintenance HD for more than six months in Mansoura Nephrology and Dialysis Unit (MNDU). The study was performed in Ramadan 1440 Hijri when the fasting hours ranged from 15 to 16 hours. Patients’ nutritional status was assessed by malnutrition inflammation score (MIS). Anthropometric measurements, including body weight, height, mid arm circumference (MAC) and triceps skin fold thickness (TSF), were measured. Body composition was assessed by bioelectrical impedance. All of the aforementioned methods were performed before start of Ramadan and repeated three weeks after the end of the holy month in patients who fasted. Results Forty–five patients (66%) fasted more than 18 days during the month of Ramadan. The mean age of patients who fasted was 47.33±14.86 years with a median duration of HD of 35 months (IQR 14.5-74.5). After Ramadan, weight gain was observed in patients who fasted. However, the increase in body mass index (BMI) was statistically insignificant (28.7±6.06 vs 29.04±6.09kg/m? p=0.073). On the other hand, visceral fat was significantly reduced after Ramadan (p&amp;lt;0.0001). MIS score improved with lower score estimated after Ramadan; however, the difference was insignificant (p=0.059). Conclusion Fasting in Ramadan in HD patients was associated improvement of the metabolic profile evident by decrease in visceral fat. The effect of intermittent fasting on inflammation and nutritional parameters in patients on maintenance hemodialysis needs further investigations.

Effects of Ramadan Fasting in Patients with Chronic Myeloid Leukemia in Chronic Phase

Background Chronic myeloid leukemia (CML), is a clonal bone marrow stem cell disorder that accounts for 10% of all leukemias. Generally, CML is one of the best examples of effective targeted therapy. Today, the overall survival of patients with CML treated by using tyrosine kinase inhibitors (TKIs) is very close to that of the healthy population. However, little is known about the effect of certain measures such as fasting especially during Ramadan period. In Islam, Ramadan fasting represents one of the five pillars of creed and considered as a mandatory religious duty, although in some instances among which, patients are exempted from observing this duty. The day fasting hours in Ramadan varies according to the geographical location of countries from 11 to 22 hours. To the best of our knowledge, this is the first quantatative study evaluating the effects of Ramadan fasting on patients with CML on TKIs. Objectives The main objective of this study was to evaluate the effect of fasting on CML patients receiving TKIs by evaluating their clinical course, hematological parameters, and BCR-ABL levels. Patients &amp; Methods A retrospective study was conducted by reviewing medical records for adult Muslim patients with CML in the state of Qatar, who fasted Ramadan month during the period of 2016, 2017 and 2018, therefore we evaluated: 1) Complete Blood Count before, during, and after Ramadan. 2) BCR /ABL level before, during, and after Ramadan. 3) Any loss of hematological response or clinical evidence of disease progression like increase in spleen size during Ramadan. Patients were retrospectively asked and confirmed that they're fasting during Ramadan period by a telephone call made by the study team. Results A total of 49 patients fulfilled the criteria of the study, with median age of 46 years (range from 22-86), of these 36 (73.5%) were males and 13 (26.5%) were females, with ratio of 2.8 : 1. 27 (55.1%) patients are middle eastern, while 16 (32.7%) patients came from the Indian subcontinent, and 6 (12.25) patients were black. Multiple TKIs were used, imatinib was the most common TKI; used in 25 patients (51%), nilotinib in 15 patients (30.6%), dasatinib in 8 patients (16.3%) and ponatinib used only in one patient. Repeated measure analysis of variance (ANOVA) statistical analysis showed that the mean White blood count, neutrophils and BCR-ABL was found to be reduced after Ramadan period compared to before and during Ramadan period, however their difference was statistically insignificant (P&gt;0.05). Mean platelet, hemoglobin, basophils and eosinophils values appeared to have similar trend before, during and after Ramadan periods. Unpaired t test revealed that the mean values of the most of the hematological parameters among male was found to be higher compared to females. Age was found to be negatively correlated (low to moderate correlation) with all hematological parameters and BCR-ABL levels (Pearson correlation (r) ranges from -0.10 to -0.46). Conclusion TKIs use during fasting in Ramadan period is poorly studied with scarce data. The use of TKIs during fasting in Ramadan period did not result in significant changes in hematological indices nor in BCR-ABL levels in our study. Patients who wish to fast during Ramadan period may be reassured in this regard, yet physicians can adopt the safe trial approach, where they allow the patients to fast, but with instructions as when to break fasting. On the other hand, further research is needed to reach a definite conclusion. Table Disclosures No relevant conflicts of interest to declare.

Prednisolone or hydrocortisone replacement in patients with corticotrope deficiency fasting during Ramadan result in similar risks of complications and quality of life: a randomized double-blind controlled trial.

The aims of the study were to compare the risk of complications and the quality of life in patients with corticotrope deficiency, who fasted during Ramadan. Both hydrocortisone and prednisolone were compared as treatments. A randomized double-blind crossover clinical trial conducted in the department of Endocrinology of the University Hospital la Rabta in Tunis, during Ramadan 2018, on 53 patients with known corticotrope deficiency treated with hydrocortisone 20 mg per day and who were willing to fast during Ramadan. Patients were randomized into two groups; AB that received hydrocortisone twice daily for 14 days then prednisolone once daily with a placebo for 14 days and group BA that received the two treatments in the reverse order. Patients had to complete a daily follow-up sheet about their eating and sleeping habits, the occurrence of complications and blood glucose monitoring and also to respond to the AddiQoL questionnaire at the end of each treatment period. Fifty patients' data were analyzed; 29 men, mean age: 42.4 ± 13.3 years, mean duration of the disease: 8.1 ± 7.6 years. The frequency of complications, mean blood glucose levels and the quality of life did not differ on hydrocortisone compared to prednisolone after adjustment for the sequence of the treatment. the risks of Ramadan fasting in patients with corticotrope deficiency were the same on hydrocortisone or prednisolone.

Metabolic effects of Ramadan fasting in patients at high risk of cardiovascular diseases.

Background and aimThe effects of Ramadan fasting on health are a little controversial. The present study is aimed at evaluating the metabolic effects on a group of 517 patients with ≥2 cardiovascular risk factors over a period running from 2012 to 2014.MethodsEach patient was assessed at three visits: before, during, and after Ramadan. Demographical, clinical and biological tests were performed at each visit.ResultsMetabolically, we noted a significant and discrete rise in blood glucose level (+1.2 mmol/L), triglycerides (+0.3 mmol/L), cholesterol (+0.12 mmol/L) and creatinine (+3 µmol/L) during Ramadan. These disturbances decreased significantly after Ramadan. The same variations were observed among diabetics (n=323). However, there was a significant decrease in HbA1c after Ramadan (9.0% vs 7.6%, p<0.001). Our findings also revealed there was no significant correlation between variations of metabolic parameters and dietary intake. No acute metabolic incidents were reported during the study period.ConclusionThe current study showed that Ramadan is responsible for a transient but well tolerated disturbance of metabolic parameters followed by a significant post-Ramadan improvement. These changes did not seem to be directly related to dietary intake.

Initial increase in glucose variability during Ramadan fasting in non-insulin-treated patients with diabetes type 2 using continuous glucose monitoring

ABSTRACTThere are no studies evaluating the glucose variability in different periods of Ramadan fasting in patients with type 2 diabetes using continuous glucose monitoring (CGM). This study examined the effect of Ramadan fasting on interstitial glucose (IG) variability in early,- late-, and post-Ramadan compared to pre-Ramadan days in non-insulin-treated type 2 diabetes patients. Participants had a CGM system connected 2 or 3 days before Ramadan start, which was removed on the third or fourth day of Ramadan. CGM performance continued for a total of 6 days. A second CGM performance started on the 27th or 28th day of Ramadan and ended on the 4th or 5th post-Ramadan day. First, CGM recordings were divided into pre-Ramadan and early-Ramadan CGM, and second recordings into late-Ramadan and post-Ramadan. At each visit, blood pressure, body weight, and waist circumference were measured, and fasting blood samples were collected for HbA1c and plasma glucose. All patients received recommended Ramadan education before Ramadan. Thirty-three patients (mean age 55.0 ± 9.8 years, 73% males) were prospectively included. IG variability, estimated as mean amplitude of glycaemic excursions (MAGE), increased significantly in early-Ramadan compared to pre-Ramadan (P = 0.006) but not in late-Ramadan and post-Ramadan recording days. Only patients on >2 anti-diabetic drugs (n = 16, P = 0.019) and those on sulphonylureas (n = 14, P = 0.003) showed significant increase in MAGE in early-Ramadan. No significant changes were seen in coefficient of variation, time in range, time in hyperglycaemia, or time in hypoglycaemia. Except for an initial increase in glucose variability, fasting Ramadan for patients with non-insulin-treated type 2 diabetes did not cause any significant changes in glucose variability or time in hypoglycaemia during CGM recording days compared to non-fasting pre-Ramadan period.

Higher rate of hyperglycemia than hypoglycemia during Ramadan fasting in patients with uncontrolled type 1 diabetes: Insight from continuous glucose monitoring system

BackgroundPatients with uncontrolled type 1 diabetes mellitus (T1DM) are at a high risk for Ramadan fasting and are exempt from fasting; however, most still insist on fasting. The aim of this study was to examine glucose level fluctuations in those patients during Ramadan fasting using a real-time continuous glucose monitoring system (RT-CGMS). MethodsThis pilot study involved adult patients with uncontrolled T1DM (HbA1c > 7%) who insisted on fasting during Ramadan in 2014 from Maternity and Children’s Hospital, Medina, Saudi Arabia. A Medtronic RT-CGMS was used to monitor the participants’ glucose levels for 3 consecutive days during fasting. ResultsThe study included 22 patients (mean age 22 ± 6 years, duration of diabetes 10.9 ± 7.2 years, HbA1c level 9.3 ± 1.2). All participants were using the basal-bolus insulin regimen, except for one patient who was on an insulin pump. Sensor glucose (SG) profiles typically followed a pattern that was characterized by an exaggerated increase after iftar, which was sustained overnight, and a second rapid rise after suhoor, with a prolonged glucose decay over the daylight hours. The average SG was 199 ± 104.1 mg/dl, which was lower during fasting 188.4 ± 103.41 mg/dl than during the eating hours 212.5 ± 103.51 mg/dl (P = 0.00). There was a higher rate of hyperglycemia (48%) than hypoglycemia (10%). ConclusionsPatients with uncontrolled T1DM who fasted during Ramadan experienced a wide fluctuation of glucose levels between fasting and eating hours, exhibiting a greater tendency toward hyperglycemia. The long-term effects for this finding are not known and warrant further investigation.

The risk for hypoglycemia during Ramadan fasting in patients with adrenal insufficiency.

The risk for hypoglycemia during Ramadan fasting in patients with adrenal insufficiency (AI) is not fully known. The aims of this study were to evaluate this risk objectively and to determine the associated factors. This prospective case-crossover study included 25 women and 5 men with known and treated AI and a median age of 38.5y. Patients underwent clinical examination and a fasting blood sample was collected to measure glucose, urea, creatinine, sodium, potassium, cortisol, growth hormone and free thyroxine. A 24-h continuous glucose monitoring system (CGMS) using iPro2 (Medtronic, Parsippany, NJ, USA) with Enlite sensor (Medtronic) was performed for each patient during a Ramadan fasting day then again during a nonfasting day. Interstitial glucose levels during the 24-h period, the fasting period, and the fasting period after exclusion of the 5 postprandial hours were significantly lower during the fasting day than on the nonfasting day. Hypoglycemia occurred in three patients (10%) during the fasting day but not during the nonfasting day (P=0.23). Hypoglycemia was asymptomatic in two cases. Male sex was significantly associated with the occurrence of hypoglycemia. Interstitial glucose levels were lower during fasting in patients with AI. However, the risk for hypoglycemia was not increased.

Ramadan fasting in patients with adrenal insufficiency

The risks of fasting during Ramadan in patients with adrenal insufficiency are unknown. The aims of this study were to evaluate these risks in such patients, to determine the risk factors and finally to set some recommendations. It is a cross-sectional study about 180 patients with known and treated adrenal insufficiency. The patients responded to a 14-item questionnaire concerning their knowledge about the disease and fasting during the last month of Ramadan. There were 132 women and 48 men. The mean age was 47.6 ± 15.0 years (14-79). One hundred and thirty eight patients (76.7 %) were advised by their physician not to fast. Ninety-one patients (50.5 %) tried to fast. Complications occurred in 61 cases (67.0 %): asthenia in 88.5 % of cases, intense thirst in 32.8 %, symptoms of dehydration in 49.2 % and symptoms of hypoglycaemia in 18 %. One patient was hospitalized. Fifty-five patients (60.4 %) were able to fast for the whole month. Age, gender, duration of the disease, its primary origin, associated hypothyroidism, diabetes mellitus, hypertension or diabetes insipidus and daily dose of hydrocortisone did not significantly differ between fasters and non-fasters, full-month-fasters and partial-month-fasters, and fasters with complications and fasters without complications. The frequency of adequate knowledge about the disease was significantly higher in full-month-fasters vs. partial-month-fasters, and in fasters without complications vs. those with complications. In patients with adrenal insufficiency, fasting can cause complications especially if the level of knowledge about the disease is low.

Does Lipid Profile Affect Thrombin Generation During Ramadan Fasting in Patients With Cardiovascular Risks?

There is evidence that diet and variation in lipid metabolism can influence blood coagulation, but little is known about the effect of Ramadan fasting on plasmatic coagulation pattern. We investigated the effect of Ramadan fasting on thrombin generation (TG) in patients with cardiovascular disease (CVD) risks, and we aimed to assess the effect of lipid profile on TG parameters. The study was conducted in 36 adults having at least 2 CVD risks and in 30 healthy controls. Coagulation pattern was assessed by both classical clotting times and TG test. A complete lipid profile was performed simultaneously. Patients were invited 2 times: 1 week before Ramadan and during the last week of the Ramadan. The TG parameters were not different in patients with CVD risks compared to healthy controls. Fasting had no effect on plasmatic coagulation parameters and on TG profile. Individual analysis of the mean rate index (MRI) of TG revealed 3 groups: group 1 with no modification of MRI, group 2 with a significant increase in MRI (81.64 nM/min vs 136.07 nM/min; P < .001), and group 3 with a significant decrease in MRI (125.27 nM/min vs 73.18 nM/min; P = .001). Only in group 2, a significant increase was observed in total cholesterol and low-density lipoprotein cholesterol. Changes in lipid profile during Ramadan fasting did not influence the global coagulation pattern in patients with CVD risks. Whereas, a significant increase in the propagation phase of TG was associated with a significant increase in cholesterol levels, which was not found with the other TG parameters.

Type 1 diabetes and fasting during Ramzan

AbstractFasting is one of the five pillars of Islam, and consequently, even the Muslims with diabetes prefer to fast fast during Ramadan, irrespective of the healthcare implications. However, this fast can be very difficult to manage in patients of Type 1 diabetes (T1DM), who are on insulin therapy. Risks of diabetic ketoacidosis, severe hypoglycaemia, hyperglycemia, dehydration and thrombotic episodes are increased. Lack of proper pre-fast assessment, management and diabetes education have been stumbling blocks in facilitating Ramadan fasting in type 1 diabetes patients. Recent developments like the use of insulin pumps and analogs and recognition of the importance of structured diabetes education and assessment to select the patients best suited for the rigors of fasting, have wrought a sea change in the usually negative approach of doctors towards Ramadan fasting in patients with T1DM. Sophisticated therapeutic options like smart insulins, can provide safer and more convenient options for management of Type 1 diabetes during Ramadan, a few years down the line. More studies are also needed to explore other options like GLP-1 agonists, alpha glycosides inhibitors and DDP-4 agonists, as adjuncts to insulin therapy.