Safety Of Ramadan Fasting Research Articles

Safety and effectiveness of newer antidiabetic medications during Ramadan fasting and safety of Ramadan fasting after bariatric surgery.

Fasting during Ramadan is mandatory for all adult healthy Muslims. International studies found that most Muslims with diabetes mellitus fast during Ramadan. The main risk factors are hypoglycemia, Hyperglycemia, diabetic ketoacidosis, and dehydration during fasting. Therefore, stratification of the risks for severe acute diabetes complications needs to be considered for each individual and strategies personalized to advert these complications. The advent of new diabetes medications which are effective yet with a better safety profile and monitoring of blood glucose levels during the day are important to reduce the risk of untoward effects of hypoglycemia and hyperglycemia during Ramadan fasting. Here we review the safety and effectiveness of the newer diabetes medications for Ramadan fasting and whether it is safe to perform fasting after bariatric surgery. An extensive literature search using PubMed and Google Scholar was done using different search terms. The eligible studies were 48 randomized controlled trials, prospective observational studies, and reviews from January 2008 to June 2022 which were conducted inindividuals living with diabetes. The newer diabetes medications such as GLP-1 agonists, DPP-4 inhibitors, SGLT-2 inhibitors, and new Insulin therapy are thought to be safe and effective during fasting of Ramadan. These medications are associated with a reduction in HbA1c, body weight, systolic blood pressure and risk of hypoglycemia during Ramadan fasting. However, further studies with larger sample size are needed to confirm the efficacy and safety of these newer medications during Ramadan fasting. Individuals with Bariatric surgery should seek advice and approval to fast from the bariatric dietician, physician, and surgeon before the beginning of the month of Ramadan.

Biometric and metabolic changes in patients with diabetes prior, during and after the holy month of Ramadan (ABCD Study)

Physiological impact of the intermittent or prolonged fasting is known from various studies on healthy subjects. However, data on impact of fasting on biochemical and biometric parameters in people with diabetes is building up. Safety of Ramadan fasting has always been assessed after Ramadan. This study looked into the immediate effect of fasting during the fasting days compared to time before and after the fasting month. Methods: This is an observational study. We looked into people with biometric and biochemical records before Ramadan, and we followed them up during and after Ramadan prospectively. We were aiming for assessing the biochemical and biometric changes for people with diabetes during Ramadan in comparison to pre-and post Ramadan. As well as the differences between these measures according to type and treatment of diabetes in those who fasted as well as in those who did not fast during Ramadan. Results: Total of 342 patients were recruited to the study. All were patients with diabetes at a mild to moderate risk of complications if fasted. Majority were males 52.3% (n = 180), while females were 47.7% (n = 162). Most of the results showed a U shape between Pre-Ramadan, During Ramadan and Post-Ramadan periods. there was a modest but significant reduction in weight but regained after Ramadan. Conclusions: Our study suggests that for many people with diabetes fasting is not associated with an increased risk to their glycemic control, their weight and/or their blood pressure. Indeed, what is seen is marginal benefit or no change in all parameters. This stratifies the ongoing recommendation that allows patients with categorized as low risk to fast Ramadan or non-Ramadan days whenever desired.

Impact of provision of optimum diabetes care on the safety of fasting in Ramadan in adult and adolescent patients with type 1 diabetes mellitus

BackgroundAll diabetes and Ramadan guidelines advice against fasting for people with type 1 diabetes, however, many insist on fasting. Consequently, this causes a challenge due to the risk of hypoglycaemia, hyperglycemia ± diabetic ketoacidosis. AimTo assess the impact of optimum care, which includes Ramadan-focused education, flash glucose monitoring, dietary advice and treatment adjustment on the safety of Ramadan fasting in people with type 1 diabetes. MethodsThirty persons with type 1 diabetes who insisted to fast during Ramadan were recruited to the study. At pre-Ramadan visit, all patients received Ramadan focused education and Freestyle Libre (FSL) sensor insertion and training. Patients used the sensor for 6 weeks (pre-Ramadan and during Ramadan). The physical and biological parameters were collected 2–4 weeks before and after Ramadan. Results22 patients on basal bolus insulin and 2 on an insulin pump had FSL data. Average number of days fasted were 24. Learning benefits was reported by 95% of patients following pre-Ramadan educational session. There was no clinically significant change in physical and/or biological data between pre and post-Ramadan. 63% reported making insulin dose adjustments in Ramadan. Flash glucose monitoring data showed 46.7% of patients had more than 10 hypoglycemic episodes in the 2 weeks prior to Ramadan compared to 29.2% during Ramadan. However, none of the data were statistically significant apart from HbA1c which reduced from prior to RamadanHbA1c of 8.2% to 7.9% post Ramadan (P 0.010). There was one DKA on 2nd day of Ramadan, reported due to missing insulin dose to avoid hypoglycemia. ConclusionOptimal care of selective patients with type 1 diabetes with a low complication rate may allow Ramadan fasting with improvement in glycemic control and without an increase in hypoglycemia, biometric or metabolic parameters. Larger, randomized controlled trials are required to be able to generalize this as a recommendation.

Fasting in Ramadan is safe for Individuals Suffering from Type 2 Diabetes Mellitus in Pakistan

Background: Whether diabetics should fast or not in Ramadan has been a controversial idea since long and the answer even more debatable. It confers safety measures to be known by the diabetics thoroughly, such as when to break the fast and what the hypoglycemic cut offs are. We aimed to determine hypoglycemic events and safety of Ramadan fasting among individuals with Type 2 Diabetes Mellitus (DM). Methods: This was an observational study enrolling diabetics who decided to fast in Ramadan, were aged >18 years, visited the primary health care center in Sikanderabad and Clifton clinic and gave consent to participate in the study. The exclusion criteria was Type 1 Diabetes Mellitus, Gestational diabetes, drug induced Diabetes and Maturity Onset Diabetes of the Young. A total of 103 participants were included in the study. Data was captured pre-Ramadan, during Ramadan and post-Ramadan in the year 2019. Multivariate Logistic regression was computed and chi-square taken for association of risk factors with hypoglycemia. P-value <0.05 was considered significant. Results: Mean HbA1c before Ramadan was 9.2%+2.1 and after Ramadan 7.7%+1.4 (P-value<0.05) showing a reduction of 1.5%. Mean weight of the patients before Ramadan was 68.3kg+1.6 and during Ramadan 64.8kg+1.4(p-value <0.00) showing a dip of 3.5 kg however mean weight 1 month after Ramadan was 66.5kg+14.9 depicting a rise again of 1.8kgs. Higher the risk category of American Heart Association, those who had hypoglycemic events before Ramadan and those on basal-bolus combination insulin had more hypoglycemic events (p-value <0.05). Conclusion: Fasting in Ramadan shows a major reduction in weight (3.5kg) as well as corrects hyperglycemia (1.5%). However, hypoglycemia was attributed to high risk patients only hence Ramadan fasting proved to be quite safe in individuals with Type 2 DM.

The effect of Ramadan fasting on kidney function in patients with chronic kidney disease.

Because of the increase in globalization, clinicians all over the world are confronted the questions about safety of Ramadan fasting. However, there is no clear information about whether there is an obstacle for fasting patients with chronic disease. Hence, in the present study, we aimed to investigate the effects of Ramadan fasting on kidney and the factors affecting this relationship in patients with chronic kidney disease. This study involving 117 patients [36 females, 81 males; mean age, 60 (46.0-70.0) years] with stage 2-3 chronic kidney and fasting. Patients were evaluated every 10 days for acute kidney injury (AKI) in Ramadan month. And, patients with acute kidney injury and patients without AKI were grouped. When the patients were evaluated for AKI, we observed that in 27 patients had acute kidney injury. While patients without AKI fasted for more days (p<0.001), urea levels and frequency of hypertension were higher in the group with AKI (p=0.019; p=0.025 respectively). We also performed univariate and multiple binary logistic regression analysis to identify the risk factors of AKI. Hypertension and number of fasting day were found to be predictive of AKI (p=0.02; p<0.001 respectively). We found a significant relationship between hypertension, the number of fasting days and acute kidney injury. Patients with chronic kidney damage and hypertension should be evaluated more carefully, informed about the importance of hydration after fasting and should be followed frequently for AKI.

The 8th Diabetes and Ramadan International Alliance Conference: January 23–24, 2020, Dubai, United Arab Emirates

The 8th Ramadan and Diabetes International Alliance Annual Conference was held over 2 days on January 24th and 25th in Dubai, United Arab Emirates. The program included six sessions in total. The three states of the art lectures addressed (a) an overview of the current knowledge on insulin therapy during Ramadan, (b) journey of diabetes from EPIDIAR, to CREED and ending by DAR-MENA-T2DM, and (c) feasibility and management of fasting after bariatric surgery. Sessions on the 1st day considered four themes spanning from the impact of Ramadan on physical and mental well-being, efficacy and safety of newer antidiabetic medications during Ramadan, adherence to medications for diabetes and hypothyroidism, and the safety of Ramadan fasting in high-risk groups (cardiovascular and renal). The 2nd day started with a session on bridging the gap between physicians and religious scholars, including a live question and answer session “ask the imam.” The rest of the sessions covered management of type 1 diabetes during Ramadan, patients and doctors perceptions of fasting from various regions and finally a scientific session on nutrition and weight management during Ramadan. RaD activities seem to develop progressively in variety and quality of content and also far-reaching audiences and participants.

The effects of Ramadan fasting on clinical and biochemical markers among hemodialysis patients: A prospective cohort study.

BackgroundRamadan fasting is compulsory for all healthy adult Muslims. Although sick people are exempted from Ramadan fasting, some patients such as hemodialysis patients prefer to fast during Ramadan. The effect of Ramadan fasting on clinical outcomes and biochemical markers among hemodialysis patients is not clear. The aim of this study was to examine the effects of daily Ramadan fasting and partial Ramadan fasting on key biochemical and clinical markers among hemodialysis patients as compared to hemodialysis patients who chose not to fast during Ramadan.MethodsA prospective cohort study of 269 end stage renal disease patients were recruited from the hemodialysis unit in An-Najah National University Hospital, Nablus, Palestine. The participants were divided into three cohorts based on their plans for fasting during Ramadan in May 2018; Ramadan fasting group (RFG), Ramadan partial fasting group (RPFG) and Ramadan not-fasting group (RNFG). Key clinical and biochemical markers were measured before, during and after Ramadan.ResultsAfter adjustment for diabetic and hypertension status and other sociodemographic variables, RFG had higher mean inter-dialytic weight gain (IDWG) by 0.62 kg than RNFG (95% confidence interval (CI) 0.26, 0.99). RPFG also had slight increase in mean IDWG than RNFG by 0.35 kg (95% CI 0.11, 0.60). Additionally, RFG and RPFG had significant increase in mean serum potassium as compared to RNFG. Diabetes was independently associated with increased IDWG by 0.48 kg (0.25, 0.72). Diabetes and hypertension were associated with some independent changes in biochemical markers, but these were clinically negligible.ConclusionOur findings suggest that Ramadan fasting (fully or partially) is tolerable by hemodialysis patients and is not associated with important clinical complications. However, these patients should be made aware of the potential risk of fluid overload and hyperkalemia, if they decide to fast during Ramadan. Thus, they should be closely monitored and instructed to adhere to their dietary and fluid intake allowances. Further prospective cohort studies with comprehensive dietary measures and information on adverse clinical outcomes may provide more evidence about the tolerability and safety of Ramadan fasting by hemodialysis patients.

Safety of Ramadan fasting in young patients with type1 diabetes: A systematic review and meta-analysis.

Aims/IntroductionAlthough patients with type 1 diabetes are medically exempt, many insist on fasting during Ramadan. Multiple daily insulin injections (MDI), premixed insulin and continuous subcutaneous insulin infusion (CSII) are commonly used. To date, little is known about the safety of Ramadan fasting in these patients.Materials and MethodsWe pooled data from 17 observational studies involving 1,699 patients treated with either CSII or non‐CSII (including premixed and MDI) regimen. The study outcomes were the frequencies of hypoglycemia, hyperglycemia and/or ketosis. Given the lack of patient‐level data, separate analyses for premixed and MDI regimen were not carried out.ResultsThe CSII‐treated group (n = 203) was older (22.9 ± 6.9 vs 17.8 ± 4.0 years), and had longer diabetes duration (116.7 ± 66.5 vs 74.8 ± 59.2 months) and lower glycated hemoglobin (7.8 ± 1.1% vs 9.1 ± 2.0%) at baseline than the non‐CSII‐treated group (n = 1,496). The non‐CSII‐treated group had less non‐severe hypoglycemia than the CSII‐treated group (22%, 95% CI 13–34 vs 35%, 95% CI 17–55). Of the non‐CSII‐treated group, 7.1% (95% CI 5.8–8.5) developed severe hypoglycemia, but none from the CSII‐treated group did. The non‐CSII‐treated group was more likely to develop hyperglycemia (12%, 95% CI 3–25 vs 8.8%, 95% CI 0–31) and ketosis (2.5%, 95% CI 1.0–4.6 vs 1.6%, 95% CI 0.1–4.7), and discontinue fasting (55%, 95% CI 34–76 vs 31%, 95% CI 9–60) than the CSII‐treated group.Conclusions The CSII regimen had lower rates of severe hypoglycemia and hyperglycemia/ketosis, but a higher rate of non‐severe hyperglycemia than premixed/MDI regimens. These suggest that appropriate patient selection with regular, supervised fine‐tuning of the basal insulin rate with intensive glucose monitoring might mitigate the residual hypoglycemia risk during Ramadan.

The role of optimum diabetes care in form of Ramadan focused diabetes education, flash glucose monitoring system and pre-Ramadan dose adjustments in the safety of Ramadan fasting in high risk patients with diabetes

BackgroundPhysiology of intermittent and prolonged fasting is known from healthy subjects. Evidence on high and very high-risk groups is lacking. The anticipated risks include hypoglycemia, hyperglycemia, dehydration and thrombosis. Education, pre-Ramadan doses adjustment, and glucose monitoring devices (Optimum diabetes care in Ramadan) is expected to lower this risk. AimsWe aimed to assess the value of optimum care in diabetes management during Ramadan on the metabolic parameters of high risk patients with diabetes. Moreover, we wanted to assess and understand the safety of fasting in this group. MethodsThis is a prospective interventional study. Patient with high-risk diabetes who insisted on fasting. High risk patients defined as any one with type 1 or type 2 diabetes on insulin, Gestational diabetes, stage 3 kidney disease, and having history of ischemic heart disease. All patients received a Freestyle Libre continuous glucose monitoring device, and was offered to attend the clinic at any time during the study, this collectively defined as optimum diabetes care during Ramadan. Biometric (Weight, height, Blood pressure) and biochemical (Glycosylated hemoglobin A, Lipids profile, creatinine, and estimated glomerular filtration rate) were reported within 4–6 weeks before and after Ramadan. ResultsTotal of 169 patients were. Majority were females 54.4% (n = 92). There was a remarkable improvement in glycemic control from 7.6 + 1.2 to 7.3 + 1.2 percent (p = 0.00). Serum creatinine showed a negligible change at the end of the study from 0.81 + 0.3 to 0.82 + 0.2 mg/dl). Only total cholesterol worsened significantly (p = 0.02).

Safe Ramadan Fasting Is Possible for Subjects with Poorly Controlled Type 2 Diabetes Mellitus

Background: Poorly controlled diabetic patients (PCDP) are at increased risk during Ramadan fasting. International guidelines caution against Ramadan fasting among PCDP. However, many PCDP fast against medical advice. To our knowledge, no studies have specifically addressed the safety of Ramadan fasting by PCDP and hence, we aimed to study this. Methods: Adults with type 2 DM attending a tertiary hospital’s Endocrinology clinic, who had fasted for at least 2 weeks in Ramadan, were evaluated. The safety and biochemical parameters were compared between the 2 groups based on pre- Ramadan glycemic control-Group 1 (HbA1c &amp;lt;9%) and group 2 (PCDP, HbA1C ≥ 9%). Results: We evaluated 139 Ramadan fasts by 113 participant-70 fasts were by PCDP, of which 26 were studied twice (2016 and 2017). The results are summarised below. Hypoglycemia was more frequent in group 1 compared to PCDP (p = 0.017). However, there was no significant difference in other safety parameters between both groups. None of the PCDP suffered from hyperglycemia related complications. Conclusion: Most of the PCDP in our cohort were able to fast safely during Ramadan. Our findings need to be confirmed with prospective studies in different ethnic and geographic settings. PCDP with no prior hyperglycemic crisis can fast during Ramadan safely if specific education is offered and may even harness the beneficial effects of Ramadan such as metabolic memory. CharacteristicsGroup 1 (N = 69; mean HbA1c 7.8%)Group 2 (N = 70; mean HbA1c 10.8%)No. of days fasted (Mean)26.927.7Polydipsia (N)813Hypoglycemia (N)149Hyperglycemia (capillary blood glucose &amp;gt; 16 mmol/L, N)912Need to break fast due to hypoglycemia (N)149Need to break fast due to hyperglycemia (N)00Hyperglycemic crisis/ DM related hospital admissions (N)00Mean HbA1c change (%) pre and post-Ramadan+ 0.18- 0.28 Disclosure Y. Chee: None. S. Ng: None. K.J. Kwek: None. S. Abdul Shakoor: None.

Are babies conceived during Ramadan born smaller and sooner than babies conceived at other times of the year? A Born in Bradford Cohort Study

BackgroundIt is not known whether infants exposed to intermittent maternal fasting at conception are born smaller or have a higher risk of premature birth than those who are not. Doctors...