Optimizing Ramadan fasting: A randomised controlled trial for people with type 2 diabetes during Ramadan applying the principles of the ADA/EASD consensus.

Autor: Ibrahim M; EDC, Centre for Diabetes Education, Charlotte, North Carolina, USA., Barker MM; Diabetes Research Centre, University of Leicester, Leicester, UK., Ahmad E; Diabetes Research Centre, University of Leicester, Leicester, UK., Ahmed A; Agha Khan University Hospital, Karatchi, Pakistan., Annabi FA; Islamic Hospital, Amman, Jordan., Ba-Essa EM; Sumuo Medical Centre, Dammam, Saudi Arabia., Davies MJ; Diabetes Research Centre, University of Leicester, Leicester, UK., Houeiss P; Medical Faculty, Paris University, Paris, France., Iraqi H; Faculty of Medicine and Pharmacy, Department of Endocrinology, Mohamed V University, Rabat, Morocco., Masood SN; Department of Obstetrics and Gynecology, Isra University, Karachi, Pakistan., Mimouni-Zerguini S; Department of Endocrinology, Diabetology & Metabolic Diseases, Pierre & Marie Curie Center, University of Algiers, Alger Ctre, Algeria., Shaikh S; Saifee Hospital, Mumbai, India., Tantawi H; Ain Shams University, Cairo, Egypt., Tuomilehto J; Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.; Diabetes Research Unit, King Abdulaziz University, Jeddah, Saudi Arabia.
Jazyk: angličtina
Zdroj: Diabetes/metabolism research and reviews [Diabetes Metab Res Rev] 2023 Mar; Vol. 39 (3), pp. e3604. Date of Electronic Publication: 2023 Jan 11.
DOI: 10.1002/dmrr.3604
Abstrakt: Background: Fasting during the holy month of Ramadan is one of the five pillars of Islam. Fasting is not meant to create excessive hardship on the Muslim individual according to religious tenets. It is important that health professionals are aware of potential risks associated with fasting during the month of Ramadan (mainly hypoglycemia and hyperglycemia).
Aims: To explore the impact of applying the principles of our 2020 recommendations for the management of type 2 diabetes (T2D) during the month of Ramadan.
Methods: A multinational randomized controlled trial (RCT) was conducted in five Muslim majority countries. Six hundred and sixty participants were deemed eligible for the study; however, 23% declined to participate later for various reasons. In total, 506 participants were enroled and were equally randomized to the intervention or the control group. At the end of the study, data from 231 participants in the intervention group and 221 participants from the control group were collected after 12.6% and 8.7% were, respectively, lost to follow-up. Participants were randomized to receive a Ramadan-focussed education with treatment for diabetes adjusted as per our 2020 recommendation update compared with the local usual care (control group). Results are presented using mean, standard deviation, odds ratio (OR), and percentages.
Results: At the end of the study, the number of hypoglycemic episodes in the intervention group was less than in participants who received usual care. The intervention group had significantly lower severe hypoglycemia compared to the control group with an OR of 0.2 [0.1-0.8]. Compared to baseline, both groups had a significant reduction in glycated haemoglobin (HbA1c), but the improvements were significantly greater in the intervention group. Whilst body weight reduced and high-density lipoprotein cholesterol increased with the intervention, these changes were not significantly different from usual care.
Conclusions: A pre-Ramadan assessment of people with T2D coupled with pre-Ramadan education and an adjustment of glucose-lowering treatment as per our updated 2020 recommendations can prevent acute complications and allow a safer fast for people with T2D. We have shown that such an approach reduces the risk of developing severe hypoglycemia and improves the metabolic outcomes in people with T2D.
(© 2022 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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