Influence of Ramadan Fasting on Hemoglobin A1C, Lipid Profile, and Body Mass Index among Type 2 Diabetic Patients in Najran City, Saudi Arabia
DOI:
https://doi.org/10.3889/oamjms.2021.6084Keywords:
Type 2 diabetes mellitus, Ramadan, Glycemic control, Lipid profile, Body weight, Blood pressure, Najran, Saudi ArabiaAbstract
BACKGROUND: Saudi Arabia is known to have one of the highest prevalence of diabetes in the world. The impact of Ramadan fasting on the health of type 2 diabetic patients is an important issue that has not been adequately investigated.
AIM: The current study was aimed at assessing the impact of Ramadan fasting on hemoglobin A1C (HbA1c), lipid profile, blood pressure, and body mass index (BMI) in adult Saudis with Type 2 diabetes residing in Najran city.
METHODS: This is a descriptive cross-sectional study which enrolled 289 patients who chose to fast during the month of Ramadan and were attending the outpatient clinics of Najran University Hospital. Fasting blood samples were taken 1 month before and 1 month after Ramadan to determine glycated hemoglobin and fasting lipid profile (low-density lipoprotein [LDL], high-density lipoprotein [HDL], triglyceride [TG], and total cholesterol [TC]) and BMI was also calculated. Information regarding demographics and physical activity was obtained through a questionnaire.
RESULTS: As many as 176 (60.9%) of the participants reported to be physically inactive during Ramadan. There was a statistically significant (p < 0.05) decrease in the mean percentage of HbA1c when comparing before Ramadan (9.85 ± 2.37%) with after Ramadan (7.65 ± 1.70%). Furthermore, statistically significant difference (p < 0.05) was detected in the mean concentrations of LDL before (3.39 ± 1.06 mmol/L) and after (2.40 ± 0.83 mmol/L) Ramadan. The mean concentration of TC (before = 5.98 ± 2.00 mmol/L; after = 4.05 ± 1.18 mmol/L) and TG (before = 2.97 ± 1.95 mmol/L; after = 2.65 ± 1.65 mmol/L) also reduced after Ramadan. The mean concentrations of HDL (before = 1.78 ± 0.74 mmol/L; after= 2.23 ± 0.23 mmol/L) increased after Ramadan. The mean BMI of the study participants (before = 28.30 ± 6.27; after = 27.43 ± 5.92) decreased slightly after Ramadan. The systolic blood pressure (SBP) (before= 128.10 ± 6.32; after, 123.09 ± 5.71) and diastolic blood pressure (DBP) (before = 81.21 ± 8.51; after = 79.83 ± 7.21) showed a slight reduction after Ramadan.
CONCLUSIONS: Type 2 diabetic patients who performed Ramadan fasting displayed a lowering of HbA1c, LDL, TC, and TG, and increased HDL, but had small positive effects on body weight, BMI, as well as SBP and DBP. More studies are needed with a larger population in the future to assess the potential of Ramadan fasting as a therapeutic strategy for managing Type 2 diabetes.Downloads
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Kobeissy A, Zantout MS, Azar ST. Suggested insulin regimens for patients with Type 1 Diabetes mellitus who wish to fast during the month of Ramadan. Clin Ther. 2008;30(8):1408-15. https://doi.org/10.1016/j.clinthera.2008.08.007 PMid:18803984 DOI: https://doi.org/10.1016/j.clinthera.2008.08.007
Ibrahim NK, Attia SG, Sallam SA, Fetohy EM, El-sewi F. Physicians’ therapeutic practice and compliance of diabetic patients attending rural primary health care units in Alexandria. J Family Community Med. 2010;17(3):121-8. https://doi.org/10.4103/1319-1683.74325 PMid:21359022 DOI: https://doi.org/10.4103/1319-1683.74325
Bouzid K, Molahedh Y, Hmaidi W, Mchirgui N, Bartkiz A, Talbi E, et al. Effects of Ramadan fasting on clinical and biochemical parameters for Type 2 diabetics. Atherosclerosis. 2016;1:252-93. https://doi.org/10.1016/j.atherosclerosis.2016.07.544 DOI: https://doi.org/10.1016/j.atherosclerosis.2016.07.544
Corley BT, Carroll RW, Hall RM, Weatherall M, Strong AP, Krebs JD. Intermittent fasting in Type 2 diabetes mellitus and the risk of hypoglycaemia: A randomized controlled trial. Diabet Med. 2018;35(5):588-94. https://doi.org/10.1111/dme.13595 PMid:29405359 DOI: https://doi.org/10.1111/dme.13595
Alshehri AM. Muslims’ Patients’ Medication use Behavior and Perceptions Regarding Collaboration with Pharmacists During Ramadan, Doctoral Dissertation; 2018.
Almalki MH, Alshahrani F. Options for controlling Type 2 diabetes during Ramadan. Front Endocrinol (Lausanne). 2016;7:32. https://doi.org/10.3389/fendo.2016.00032 PMid:27148163 DOI: https://doi.org/10.3389/fendo.2016.00032
Ku M, Ramos MJ, Fung J. Therapeutic fasting as a potential effective treatment for Type 2 diabetes: A 4-month case study. J Insulin Resist. 2017;2(1):5. https://doi.org/10.4102/jir.v2i1.31 DOI: https://doi.org/10.4102/jir.v2i1.31
Scherger JE. Type 2 diabetes is reversible. Internal Med Alert. 2018;40(5).
Al-Arouj M, Assaad-Khalil S, Buse J. Recommendations for management of diabetes during Ramadan: Update 2010. Diabetes Care. 2010;33(8):1895-902. https://doi.org/10.2337/dc10-0896 PMid:20668157 DOI: https://doi.org/10.2337/dc10-0896
Jaleel MA, Raza SA, Fathima FN, Jaleel BN. Ramadan and diabetes: As-Saum (The fasting). Indian J Endocrinol Metab. 2011;15(4):268-73. https://doi.org/10.4103/2230-8210.85578 PMid:22028997 DOI: https://doi.org/10.4103/2230-8210.85578
Khafaji HA, Bener A, Osman M, Al Merri A, Al Suwaidi J. The impact of diurnal fasting during Ramadan on the lipid profile, hs-CRP, and serum leptin in stable cardiac patients. Vasc Health Risk Manag. 2012;8(1):7-14. https://doi.org/10.2147/vhrm.s22894 PMid:22272070 DOI: https://doi.org/10.2147/VHRM.S22894
Sfar H, Sellami S, Boukhayatia F, Naceur KB, Mami FB. Biochemical, physiological and body composition changes in patients with Type 2 diabetes during Ramadan fasting. IJMBS. 2017;9(6):164. https://doi.org/10.4103/ijmbs.ijmbs_59_17 DOI: https://doi.org/10.4103/ijmbs.ijmbs_59_17
Kul S, Savaş E, Öztürk ZA, Karadağ G. Does Ramadan fasting alter body weight and blood lipids and fasting blood glucose in a healthy population? A meta-analysis. J Relig Health. 2014;53(3):929-42. https://doi.org/10.1007/s10943-013-9687-0 PMid:23423818 DOI: https://doi.org/10.1007/s10943-013-9687-0
Imam SA, Alalyani M. Study of effects on physiological parameters due to Ramadan fasting and its impacts on public health. IJIR. 2017;3(3):6-9.
El-Taher AM, Zabut BM. Effect of Ramadan fasting on anthropometric measures and some biochemical parameters among Type 2 diabetic patients in Gaza Governorate, Gaza Strip. IUG J Natl Stud. 2015; 21(1):1-16.
Ismail S, Shamsuddin K, Latiff KA, Saad HA. Comparing the body mass index, blood pressure and blood biochemical changes during Ramadan between high to moderate level and low level physical activity groups prior to Ramadan among overweight and obese working women. Int J Community Med Public Health. 2016;3(7):1877-83. https://doi.org/10.18203/2394-6040.ijcmph20162059 DOI: https://doi.org/10.18203/2394-6040.ijcmph20162059
Khan N, Rasheed A, Ahmed H, Aslam F, Kanwal F. Effect of Ramadan fasting on glucose level, lipid profile, HbA1c and uric acid among medical students in Karachi, Pakistan. East Mediterr Health J. 2017;23(4):274-9. https://doi.org/10.26719/2017.23.4.274 PMid:28634977 DOI: https://doi.org/10.26719/2017.23.4.274
National Institutes of Health (NIH), National Heart, Lung, and Blood Institute (NHLBI). The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Bethesda: National Institutes of Health; 2000. https://doi.org/10.1037/e310862005-001 DOI: https://doi.org/10.1037/e310862005-001
Centers for Disease Control and Prevention. US Department of Health and Human Services Physical Activity Guidelines for Americans 2008, Washington, DC; 2008.
Alshayban D, Joseph R. Health-related quality of life among patients with type 2 diabetes mellitus in Eastern Province, Saudi Arabia: A cross-sectional study. PLoS One. 2020;15(1):e0227573. https://doi.org/10.1371/journal.pone.0227573 PMid:31923232 DOI: https://doi.org/10.1371/journal.pone.0227573
Kearns K, Dee A, Fitzgerald AP, Doherty E, Perry IJ. Chronic disease burden associated with overweight and obesity in Ireland: The effects of a small BMI reduction at population level. BMC Public Health. 2014;14(1):143. https://doi.org/10.1186/1471-2458-14-143 PMid:24512151 DOI: https://doi.org/10.1186/1471-2458-14-143
Siaw MY, Chew DE, Toh MP, Seah DE, Chua R, Tan J, et al. Metabolic parameters in Type 2 diabetic patients with varying degrees of glycemic control during Ramadan: An observational study. J Diabetes Investig. 2016;7(1):70-5. https://doi.org/10.1111/jdi.12374 PMid:26816603 DOI: https://doi.org/10.1111/jdi.12374
Al-Shoumer K, Al-Asousi A, Doi S, Vasanthy B. Serum leptin and its relationship with metabolic variables in Arabs with Type 2 diabetes mellitus. Ann Saudi Med. 2008;28(5):367-70. https://doi.org/10.4103/0256-4947.51692 PMid:18779635 DOI: https://doi.org/10.5144/0256-4947.2008.367
Chamnan P, Simmons RK, Forouhi NG, Luben RN, Khaw KT, Wareham NJ, et al. Incidence of Type 2 diabetes using proposed HbA1c diagnostic criteria in the European prospective investigation of Cancer-Norfolk cohort: Implications for preventive strategies. Diabetes Care. 2011;34(4):950-6. https://doi.org/10.2337/dc09-2326 PMid:20622160 DOI: https://doi.org/10.2337/dc09-2326
di Angelantonio E, Gao P, Khan H, Butterworth AS, Wormser D, Kaptoge S, et al. Glycated hemoglobin measurement and prediction of cardiovascular disease. JAMA. 2014;311(12):1225-33. PMid:24668104
Einhorn D, Handelsman Y, Bode BW, Endahl LA, Mersebach H, King AB. Patients achieving good glycemic control (HbA1c< 7%) experience a lower rate of hypoglycemia with insulin degludec than with insulin glargine: A meta-analysis of phase 3A trials. Endocr Pract. 2015;21(8):917-26. https://doi.org/10.4158/ep14523.or PMid:26121451 DOI: https://doi.org/10.4158/EP14523.OR
US Department of Health and Human Services, CDER. Guidance for Industry: Diabetes Mellitus: Developing Drugs and Therapeutic Biologics for Treatment and Prevention; 2008. Available from: http://www.fda.gov/downloads/drugs/guidances/ ucm071624.pdf. [Last accessed on 2015 Mar 19].
Htoo ZW, Hsu WW, Rosenkranz R. Systematic review and meta-analysis: Is lifestyle modification effective for glycemic control among adults with type II diabetes in Southeast Asia? Diabetes Res Clin Pract. 2016;122:148-53. https://doi.org/10.1016/j.diabres.2016.10.008 PMid:27855340 DOI: https://doi.org/10.1016/j.diabres.2016.10.008
Hassoun AA, Al-Arouj M, Ibrahim M. The effect of vildagliptin relative to sulfonylurea as dual therapy with metformin (or as monotherapy) in Muslim patients with Type 2 diabetes fasting during Ramadan in the Middle East: The VIRTUE study. Curr Med Res Opin. 2017;33(1):161-7. https://doi.org/10.1080/03007995.2016.1243093 PMid:27684469 DOI: https://doi.org/10.1080/03007995.2016.1243093
Mafauzy M. Repaglinide versus glibenclamide treatment of Type 2 diabetes during Ramadan fasting. Diabetes Res Clin Pract. 2002;58(1):45-53. https://doi.org/10.1016/s0168-8227(02)00104-3 PMid:12161056 DOI: https://doi.org/10.1016/S0168-8227(02)00104-3
Bener A, Al-Hamaq AO, Öztürk M, Çatan F, Haris PI, Rajput KU, et al. Effect of Ramadan fasting on glycemic control and other essential variables in diabetic patients. Ann Afr Med. 2018;17(4):196-202. https://doi.org/10.4103/aam.aam_63_1 PMid:30588933 DOI: https://doi.org/10.4103/aam.aam_63_17
Ibrahim M, Al Magd MA, Annabi FA, Assaad-Khalil S, Ba-Essa EM, Fahdil I, et al. Recommendations for management of diabetes during Ramadan: Update 2015. BMJ Open Diabetes Res Care. 2015;3(1):e000108. https://doi.org/10.1136/bmjdrc-2015-000108 PMid:26113983 DOI: https://doi.org/10.1136/bmjdrc-2015-000108
McEwen LN, Ibrahim M, Ali NM, Assaad-Khalil SH, Tantawi HR, Nasr G, et al. Impact of an individualized Type 2 diabetes education program on clinical outcomes during Ramadan. BMJ Open Diabetes Res Care. 2015;3(1):e000111. https://doi.org/10.1136/bmjdrc-2015-000111 PMid:26113984 DOI: https://doi.org/10.1136/bmjdrc-2015-000111
Tiboura G, Khaled BM, Diaf M, Semeria S, Bouanani G. Effect of Ramadan fasting on serum glucose and lipid profile among Algerian Type 2 diabetes patients. Rom J Diabetes Nutr Metab Dis. 2015;22(4):385-92. https://doi.org/10.1515/rjdnmd-2015-0045 DOI: https://doi.org/10.1515/rjdnmd-2015-0045
Alabbood MH, Ho KW, Simons MR. The effect of Ramadan fasting on glycaemic control in insulin dependent diabetic patients: A literature review. Diabetes Metab Syndr. 2017;11(1):83-7. https://doi.org/10.1016/j.dsx.2016.06.028 PMid:27402028 DOI: https://doi.org/10.1016/j.dsx.2016.06.028
Al-Shafei AI. Ramadan fasting ameliorates oxidative stress and improves glycemic control and lipid profile in diabetic patients. Eur J Clin Nutr. 2014;53(7):1475-81. https://doi.org/10.1007/s00394-014-0650-y PMid:24442382 DOI: https://doi.org/10.1007/s00394-014-0650-y
Mikirova N, Hunninghake R, Casciari J, Guilliams V. Effects of micronutrient supplementation on concentrations of vitamins and minerals, inflammation and cardiovascular risk factors. Vitam Miner. 2014;3(120):2. https://doi.org/10.4172/2376-1318.1000120 DOI: https://doi.org/10.4172/2376-1318.1000120
Askari VR, Alavinezhad A, Boskabady MH. The impact of “Ramadan fasting period” on total and differential white blood cells, haematological indices, inflammatory biomarker, respiratory symptoms and pulmonary function tests of healthy and asthmatic patients. Allergol Immunopathol (Madr). 2016;44(4):359-67. https://doi.org/10.1016/j.aller.2015.10.002 PMid:27040808 DOI: https://doi.org/10.1016/j.aller.2015.10.002
Li Y, Wang DD, Ley SH, Vasanti M, Howard AG, He Y, et al. Time trends of dietary and lifestyle factors and their potential impact on diabetes burden in China. Diabetes Care. 2017;40(12):1685- 94. https://doi.org/10.2337/dc17-0571 PMid:29046327 DOI: https://doi.org/10.2337/dc17-0571
Meo SA, Hassan A. Physiological changes during fasting in Ramadan. J Pak Med Assoc. 2015;65 Suppl 5:S6-14. PMid:26013791
Dionadji M, Abdelsalam T, Hisseine A. Metabolic profile of Type 2 diabetic patients before and after Ramadan fasting at an outpatient clinic in N’Djamena. HSD. 2015;16(2):1-4.
KMS. Study the effects of Ramadan fasting on the serum glucose and lipid profile among healthy Jordanian students. Am J Appl Sci. 2007;4(8):565-9. https://doi.org/10.3844/ajassp.2007.565.569 DOI: https://doi.org/10.3844/ajassp.2007.565.569
Ajabnoor GM, Bahijri S, Shaik NA, Borai A, Alamoudi AA, Al-Aama JY, et al. Ramadan fasting in Saudi Arabia is associated with altered expression of CLOCK, DUSP and IL-1alpha genes, as well as changes in cardio metabolic risk factors. PLoS One. 2017;12(4):e0174342. https://doi.org/10.1371/journal.pone.0174342 PMid:28384165 DOI: https://doi.org/10.1371/journal.pone.0174342
Nematy M, Alinezhad-Namaghi, M, Rashed MM, Mozhdehifard, M, Sajjadi SS, Akhlaghi S, et al. Effects of Ramadan fasting on cardiovascular risk factors: A prospective observational study. Nutr J. 2012;11(1):69. https://doi.org/10.1186/1475-2891-11-69 PMid:22963582 DOI: https://doi.org/10.1186/1475-2891-11-69
Saada DA, Selselet G, Belkacemi L, Chabane OA, Italhi M, Bekada AA, et al. Effect of Ramadan fasting on glucose, glycosylated hemoglobin, insulin, lipids and proteinous concentrations in women with non-insulin dependent diabetes mellitus. Afr J Biotechnol. 2010;9(1):87-94.
Ramanathan S, Nanda N, Mookkappan S. Effect of body mass index on the association of uric acid and glycemic status in diabetes in South Indian population. Int J Clin Exp Physiol. 2017;4(1):25. https://doi.org/10.4103/ijcep.ijcep_9_17 DOI: https://doi.org/10.4103/ijcep.ijcep_9_17
Syam AF, Sobur CS, Abdullah M, Makmun D. Ramadan fasting decreases body fat but not protein mass. Int J Endocrinol Metab. 2016;14(1):e29687. https://doi.org/10.5812/ijem.29687 PMid:27279831 DOI: https://doi.org/10.5812/ijem.29687
Shadman Z, Akhoundan M, Poorsoltan N, Larijani B, Qorbani M, Hedayati M, et al. Association of major dietary patterns with cardio-metabolic risk factors in Type 2 diabetic patients. Iran J Public Health. 2016;45(11):1491-501. PMid:28032067
Maislos M, Abou-Rabiah Y, Zuili I, Iordash S, Shany S. Gorging and plasma HDL-cholesterol-the Ramadan model. Eur J Clin Nutr. 1998;52(2):127-30. https://doi.org/10.1038/sj.ejcn.1600526 PMid:9505158 DOI: https://doi.org/10.1038/sj.ejcn.1600526
Alghamdi AS, Alghamdi KA, Jenkins RO, Alghamdi MN, Haris PI. Impact of Ramadan on physical activity and sleeping patterns in individuals with Type 2 diabetes: The first study using fitbit device. Diabetes Ther. 2020;11(6):1331-46. https://doi.org/10.1007/s13300-020-00825-x PMid:32367477 DOI: https://doi.org/10.1007/s13300-020-00825-x
Elmajnoun HK, Elhag MR, Mohamed H, Haris PI, Abu-Median AB. Ramadan 2020 and beyond in the midst of the COVID-19 pandemic: Challenges and scientific evidence for action. Sudan J Med Sci. 2020;15(2):85-110. https://doi.org/10.18502/sjms.v15i5.7147 DOI: https://doi.org/10.18502/sjms.v15i5.7147
Dewanti L, Watanabe C, Ohtsuka R. Unexpected changes in blood pressure and hematological parameters among fasting and nonfasting workers during Ramadan in Indonesia. Eur J Clin Nutr. 2006;60(7):877-81. https://doi.org/10.1038/sj.ejcn.1602393 PMid:16489329 DOI: https://doi.org/10.1038/sj.ejcn.1602393
Chamsi-Pasha M, Chamsi-Pasha H. The cardiac patient in Ramadan. Avicenna J Med. 2016;6(2):33-8. https://doi.org/10.4103/2231-0770.179547 PMid:27144139 DOI: https://doi.org/10.4103/2231-0770.179547
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Copyright (c) 2020 Hatem Mohamed, Anass M. Abbas, Mohammed Ayed Huneif, Seham M. Alqahtani, Awad Mohamed Ahmed, Asaad M. A. Babker, Ehab A. M. Elagab, Parvez I. Haris (Author)
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