medwireNews: A clinical decision-making tool to assist type 2 diabetes management during fasting for Ramadan results in significant reductions in glycated hemoglobin (HbA1c) and improvements in fasting blood glucose (FBG), researchers report.
Joyce Yu-Chia Lee (University of California, Irvine, USA) and colleagues explain that the Fasting Algorithm for Singaporeans with Type 2 Diabetes (FAST) is an empowerment-based collaborative clinical decision-making tool that incorporates risk-assessment screening, Ramadan-specific patient education with self-monitoring of blood glucose (SMBG), structured glucose-lowering medication modification guidance for healthcare clinicians, and novel self-dose adjustment guidance based on SMBG readings during Ramadan.
Its efficacy was tested in a prospective trial among 97 participants (mean age 60 years, mean HbA1c 7.8% [62 mmol/mol]) with type 2 diabetes who were randomly assigned to receive the FAST intervention (n=46) or usual care without FAST (n=51) when fasting for at least 10 days during Ramadan in 2017 or 2018.
As reported in the Annals of Family Medicine, mean HbA1c fell by a significant 0.4% (4.4 mmol/mol) during Ramadan for participants in the FAST group and by a nonsignificant 0.1% (1.1 mmol/mol) in the control group. Thus, individuals in the FAST group had a significant fourfold greater improvement in HbA1c than those in the control group.
By 3 months after the post-Ramadan measurement, when participants reverted back to their usual diabetes regimen and routines, HbA1c had increased by a nonsignificant 0.2% (2.2 mmol/mol) in the intervention group and was unchanged in the control group.
During the intervention, mean FBG decreased by 3.6 mg/dL in the FAST group and increased by 20.9 mg/dL in the control group, a statistically significant difference. In this case, the decrease in FBG observed in the FAST group was sustained at 3 months, whereas it continued to increase in the control group.
The researchers also observed a greater reduction in mean postprandial glucose level with the intervention relative to the control (16.4 vs 2.3 mg/dL) but the difference between the two groups was not statistically significant.
Neither group experienced a major hypoglycemic event during Ramadan, but fewer participants in the FAST group experienced a blood glucose-confirmed minor hypoglycemic event (SMBG <72 mg/dL), at six versus one.
Lee et al say their findings “support the empowerment characteristics of the FAST tool, such as active SMBG monitoring and self-dose adjustment, which facilitate informed decision making during Ramadan.”
In an accompanying editorial, Jonathan Gabison, from the University of Michigan in Ann Arbor, USA, says that the study implications “extend beyond fasting for spiritual reasons.”
He points out that many patients with type 2 diabetes are increasingly using fasting regimens such as time-restricted feeding, alternate-day, or whole-day fasts as a strategy for weight loss or health benefits.
He believes: “While more research is needed, a protocol to manage diabetes medications safely with intermittent fasting may help keep patients safe while we learn more about the use of these strategies to help combat obesity and diabetes.”
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