Efficacy and Safety of Use of the Fasting Algorithm for Singaporeans With Type 2 Diabetes (FAST) During Ramadan: A Prospective, Multicenter, Randomized Controlled Trial

Abstract

PURPOSE We aimed to evaluate the efficacy and safety of use of the Fasting Algorithm for Singaporeans with Type 2 Diabetes (FAST) during Ramadan. METHODS We performed a prospective, multicenter, randomized controlled trial. The inclusion criteria were age ≥21 years, baseline glycated hemoglobin (HbA 1c) level ≤9.5%, and intention to fast for ≥10 days during Ramadan. Exclusion criteria included baseline estimated glomerular filtration rate <30 mL/min, diabetesrelated hospitalization, and short-term corticosteroid therapy. Participants were randomized to intervention (use of FAST) or control (usual care without FAST) groups. Efficacy outcomes were HbA 1c level and fasting blood glucose and postprandial glucose changes, and the safety outcome was incidence of major or minor hypoglycemia during the Ramadan period. Glycemic variability and diabetes distress were also investigated. Linear mixed models were constructed to assess changes. RESULTS A total of 97 participants were randomized (intervention: n = 46, control: n = 51). The HbA 1c improvement during Ramadan was 4 times greater in the intervention group (-0.4%) than in the control group (-0.1%) (P = .049). The mean fasting blood glucose level decreased in the intervention group (-3.6 mg/ dL) and increased in the control group (+20.9 mg/dL) (P = .034). The mean postprandial glucose level showed greater improvement in the intervention group (-16.4 mg/dL) compared to the control group (-2.3 mg/dL). There were more minor hypoglycemic events based on self-monitered blood glucose readings in the control group (intervention: 4, control: 6; P = .744). Glycemic variability was not significantly different between the 2 groups (P = .284). No between-group differences in diabetes distress were observed (P = .479). CONCLUSIONS Our findings emphasize the importance of efficacious, safe, and culturally tailored epistemic tools for diabetes management.

Ramadan fasting and diabetes (2020): The year in review

“…Pharmacological therapies during Ramadan generated the most interest over the last year, with several new studies evaluating both oral and injectable diabetes therapies. [23][24][25][26][27][28][29][30][31] The studies included evaluations of individual drugs, targets, and professionals' perceptions [Table 2].…”

“…Lum et al [24] evaluated the efficacy and safety of using the Fasting Algorithm for Singaporeans with T2D (FAST) during Ramadan in a prospective, multicenter, RCT. Participants were randomized to use of FAST or control (usual care without FAST) groups.…”

“…A post hoc analysis of the LixiRam trial A combination of lixisenatide prandial+BI may be a suitable treatment option for people with T2D who fast Ramadan Lum et al [24] Multiple medications…”

Preparing muslims with diabetes mellitus for Ramadan fasting in Singapore: a clinical approach and review of current practice

“…This has been found to improve glycaemic control with no major complications. [ 26 ] Empowering patients through these group- and individual-directed interventions could potentially improve their level of self-care for DM in the immediate and longer term. [ 27 ]…”

Impact of COVID-19 on Children and Young Adults With Type 2 Diabetes: A Narrative Review With Emphasis on the Potential of Intermittent Fasting as a Preventive Strategy

“…Several studies have shown that RF was associated with a positive impact in controlling blood glucose and weight loss among patients with T2D in adults (23)(24)(25). However, the findings of other studies suggested that RF could increase the risk of hypoglycaemia in some of these patients, while could not in others (26)(27)(28).…”