Ramadan in Egyptian people with type 2 diabetes: effect on cardiometabolic parameters

Abstract

Background: Most Muslims with diabetes have a strong desire to fast during the month of Ramadan but some cannot perform it because of the risk of complications such as hypoglycemia, hyperglycemia, diabetic ketoacidosis, dehydration and thrombosis. During Ramadan, the meal pattern and fluid intake are markedly altered and there are delayed and shortened periods of sleep. These changes in meal and sleep rhythm could lead to undesirable changes in metabolism and increased risk of complications. Aims: To study the effect of Ramadan fasting on metabolic parameters and cardiovascular disease risk in patients with type 2 diabetes mellitus (T2D). Methods: This cohort study was conducted on 80 people with T2D who were intending to fast during Ramadan in the year 2014; the average number of fasting hours was 15 hours. They were subjected to clinical, anthropometric and laboratory evaluation before and after Ramadan. Results: There were significant increases between pre- and post-Ramadan total cholesterol levels (3.77±1.19 mmol/l vs 5.24±1.03 mmol/l, p< 0.001), triglycerides (1.7±0.95 mmol/l vs 2.22±1.51 mmol/l, p< 0.004), LDL-C (2.03±1.08 mmol/l vs 3.04±1.19 mmol/l, p< 0.001), fasting insulin (6.1±3.7 mu/l vs 12.6±8.2 mu/l, p<0.001), HOMA IR (2.42±1.6 IU vs 7.02±8.9 IU, p< 0.001), creatinine (71.62±17.68 umol/l vs 83.11±26.53 umol/l , p< 0.001 ), systolic blood pressure (SBP) (134.9±10.8 mmHg vs 141.2±11.9 mmHg , p< 0.001 ) and diastolic blood pressure (DBP) ( 94.7±10.7 mmHg vs 101.8±11.3 mmHg, p < 0.001). The 10-year cardiovascular disease risk increased from 5.18±7.8 to 7.6±9.9 (p< 0.001). There was no significant change in body mass index. Conclusion: Ramadan fasting in Egyptian people with T2D appears to have a significant effect on lipid profiles and blood pressure that could adversely impact cardiovascular risk. Current guidance is more focused on glycemic control, with adjustments to oral hypoglycemic agents and insulin dose. Cardiovascular disease risk assessment and guidance prior to Ramadan fasting should not be overlooked.