Study of the metabolic effects of Ramadan fasting on patients with type 2 diabetes. Relation to glycemic control, hypoglycemic events and diabetic complications

Background. The aim of this study is to evaluate the metabolic effects of Ramadan fasting on patients with type 2 diabetes, and their relation to glycemic control, risk of hypoglycemia, as well as any possible effects on diabetic complications.Methods. 300 subjects with type 2 diabetes were assessed to evaluate the metabolic effects of Ramadan fasting regarding glycemic control, risk of hypoglycemia and any possible effects on diabetic complications. The examination included measurement of body mass index (BMI), blood pressure, examination of the foot for sensory loss and peripheral vascular disease (PVD) by assessing the vibration sense and calculating the ankle-brachial index (ABI) respectively. Laboratory tests included fasting plasma glucose (FPG), HbA1c, complete lipid profile, serum creatinine, urinary albumin-to-creatinine ratio (UACR) and calculation of eGFR.Results. BMI, blood pressure, FPG, and triglycerides levels were lower in patients after Ramadan compared to their levels before Ramadan, while eGFR was higher after Ramadan than it was before Ramadan. Hypo-glycemia was highest in patients treated with insulin followed by those treated with oral agents including sulfonylureas as compared to oral agents excluding sulfonylureas (p = 0.002).Conclusion. Fasting during Ramadan can affect body weight, blood pressure, glycemic parameters and the frequency of acute glycemic complications in patients with type 2 diabetes. Hypoglycemia was highest in patients treated with insulin followed by those treated with oral agents especially sulfonylureas.