Ramadan-focused education in patients with T2D yields mixed results

  • Gad H & al.
  • Diabetes Res Clin Pract
  • 16 Mar 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Ramadan-specific education for patients with type 2 diabetes (T2D) is associated with HbA1c and low-density lipoprotein cholesterol (LDL) reduction, but weight and triglycerides increase.

Why this matters

  • Despite religious exemption, many patients with diabetes choose to observe the monthlong sunrise-sunset fast.
  • Fasting can exacerbate metabolic disruptions.

Study design

  • Systematic review, meta-analysis, 16 studies.
  • Funding: None.

Key results

  • Pre-Ramadan education was significantly associated with (95% CIs):
    • HbA1c reduction (9 studies/n=2034): 
      • Standard mean difference (SMD): −0.46% (−0.65% to −0.27%).
    • LDL cholesterol reduction (7 studies/n=1359):
      • SMD: −0.09 mmol/L (P=.0002).
    • Weight gain (9 studies/n=1109):
      • SMD: 0.44 (0.06-0.81) kg.
    • Triglyceride increase (7 studies/n=1462): 
      • SMD: 0.07 mmol/L (P=.02).
  • No difference in:
    • Fasting blood glucose (4 studies/n=1272):
      • SMD: −0.28 (−1.30 to 0.75) mmol/L.
    • BMI (8 studies/n=1398):
      • SMD: −0.24 (−0.97 to 0.49) kg/m2.
    • Total cholesterol (5 studies/n=575): 
      • SMD: −0.06 (−0.22 to 0.10) mmol/L.
    • High-density lipoprotein cholesterol (6 studies/n=602):
      • SMD: 0.03 (−0.02 to 0.08) mmol/L.
    • BP (6 studies/n=999):
      • SMD: 1.36 (−7.14 to 4.41) mmHg, systolic. 
      • SMD: −0.67 (−1.90 to 0.57) mmHg, diastolic.
    • Hypoglycemia (2 studies/n=84):
      • OR: 0.58 (0.22-1.48).
      • 1 study showing 3-fold reduction not included for protocol reasons.

Limitations

  • No randomized placebo-controlled studies.
  • Cross-study heterogeneity.
  • No patients with other diabetes types.
  • Lack of power in some studies.
  • Reporting bias risk.