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Background Diabetes is a complex, chronic illness requiring continuous medical care with multifactorial risk-reduction strategies beyond glycemic control. Ongoing patient self-management education and support are critical to preventing acute complications and reducing the risk of long-term complications. Significant evidence exists that supports a range of interventions to improve diabetes outcomes. Objective This study aimed to demonstrate the impact of fasting on primarily on ẻGFR & microalbuminuria in people with type 1 diabetes and secondarily on neuropathy & retinopathy. It was conducted on 60 patients with T1DM. All patients underwent full history taking, full clinical examination and biochemical tests including FBG, 2h PPBG, HbA1c, fructosamine, s.creatinine, BUN, uACR, eGFR, fundus examination and DN4 Q. Methods This study was conducted on 60 type 1 diabetic patients with microalbuminuria intending to fast Ramadan. Patients were recruited from internal medicine and diabetes clinics of Ain Shams University. The study performed health education 2 months prior to Ramadan 1438 (2017) with follow up throughout the month and after Ramadan. The patients were on basal-bolus regimen, 36 were on lantus, 17 were on NPH and the remaining 7 patients didnot complete the follow up after Ramadan for family reasons. Results There had been significant difference between pre and post-fasting as regards weight and BMI, and non significant difference regards waist circumference. Also highly significant difference between basal and bolus doses before and during Ramadan. There had been no significant difference between pre and post Ramadan regarding fundus examination, systolic and diastolic blood pressure and a significant difference regarding DN4 Q. Regarding no. of successful fasting days and attacks of hypoglycemia, a significant difference was found. Significant difference in FBS, 2hr PPBG, BUN, s.creatinine, uACR and eGFR, and fructosamine. There was a significant positive correlation between eGFR and height, weight before Ramadan and between eGFR and height, weight after Ramadan, no. of successful fasting days Ramadan 2017. Also a significant negative correlation was shown between eGFR and A / C ratio, Cr, BUN before Ramadan and between éGFR and Cr, BUN after Ramadan. Height, BUN before and after Ramadan and A / C ratio before Ramadan were found to be independent predictors of eGFR. Conclusion Ramadan fasting appears to have significant impact on microvascular complications of type 1 DM patients. These impacts can be attributed to many factors as physical sloth, change of time and pattern of feeding, climate conditions at time of fasting especially hot humid weather predisposing to more frequent dehydration with its sequelae as well as non-compliance of some patients to the proper lifestyle, diet and medications.

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Background Recent researches show that alteration of GUT bacterial population is found to be an important factor for development of atherosclerosis either directly or indirectly through augmenting other known risk factors for atherosclerosis like; diabetes and dyslipidemia. On the other hand, many members of the gut microbiota are probiotics; Bifidobacterium and Lactobacillus are two well-known probiotics, many studies show their athero-protective role and their protective effect against insulin resistance and metabolic syndrome. Aim of the work To study the role of gut Lactobacillus Acidophilus in the development of atherosclerosis in type 2 diabetic patients (T2DM). Patients and methods The study was conducted on 64 type 2 diabetic patients, with their age ranging between 25 and 60 years old. They will be divided into two groups; Group 1: 32 Type 2 diabetic patients with atherosclerosis. Group 2: 32 Type 2 diabetic patients without atherosclerosis. All subjects in this study were subjected to Full medical history taking. Thorough clinical examination (including weight, height, BMI, blood pressure). The following laboratory investigations were done: Fasting blood glucose, two-hour post prandial, HbA1c, Fasting insulin (for HOMA IR), Lipid profile (Total cholesterol-LDL-HDL-Triglycerides), and Liver and kidney function test. Identification of stool Lactobacillus Acidophilus by Polymerase chain reaction (PCR) semi- quantitative technique. Carotid ultrasonography for estimation of intimamedia thickness (IMT). Results As regards PCR for Lactobacillus Acidophilus 68.8% of group one patients were positive for PCR for Lactobacillus Acidophilus, compared to 75.0% of group two, but there was no statistical difference among the two groups (P value = 0.578).As regards PCR cut-off time in PCR positive cases, there was a statistically significant difference among the two groups (P value= 0.016). Applying Receiver operating characteristic curve (ROC), it showed that PCR cut-off time more than 26.82 can be used as a predictor for atherosclerosis in type two diabetic patients (T2DM) with sensitivity of 72.73%, specificity of 70.83% and area under curve (AUC) of 0.723. In group one, there was a statistically significant positive correlation between PCR cut off time and the two hours post prandial blood sugar (P value= 0.005), the glycated hemoglobin (HBa1c) (P value= 0.049) and intimal media thickness (IMT) (P-value= 0.045). Conclusion Lactobacillus Acidophilus concentration is higher in type 2 diabetes patients without atherosclerosis than in atherosclerotic patients and detection of their level in stool using PCR can be used as a predictor for atherosclerosis in type two diabetes patients.