Ramadan fasting and diabetes, latest evidence and technological advancements: 2021 update

Abstract

Development of updated guidelines for management of diabetes in Ramadan Fasting is of paramount importance. Nonetheless, evidence-based guidelines in the field of Ramadan Fasting and Diabetes are scarce. Moreover, findings of some recent research such as effects of Ramadan fasting on microbiota, genetics and epigenetics, hormonal changes (such as adiponectin, leptin, testosterone…), and alternations in circadian rhythm should also be reviewed and included on a yearly basis. It is documented that self-monitoring of blood glucose (SMBG) is of vital importance for patients with type 1 diabetes who fast, and advantages of continuous glucose monitoring (CGM) or flash glucose monitoring (FGM) techniques should be highlighted. Moreover, the recent findings about applications of advanced insulin delivery technology in patients with diabetes who fast in Ramadan should also considered in the annual updates of the guidelines.

Ramadan fasting and weight change trajectories: Time-varying association of weight during and after Ramadan in low-income and refugee populations

“…As of 2017, approximately 1�8 billion people worldwide observed the Muslim faith [1], and 90% fast during Ramadan [2,3]. The practise of abstaining from food, water, and other activities is a pillar of the Islamic religious praxis with enormous public health implications that are not yet well understood [4,5]. Therefore, this period of religious observance represents a large-scale dietary and lifestyle intervention that affects approximately 20% of the world's population each year [3,4].…”

“…Fasting and intermittent fasting, which generally does not include abstention from water, have been shown to improve health outcomes in chronic diseases [6][7][8]. By contrast, the longterm health benefits or risks of Ramadan fasting are unclear [5,[9][10][11][12][13][14]. In observant populations, general practices of Ramadan may include an iftar meal to break one's fast after the sun sets and suhoor, a light pre-dawn meal [15].…”

“…Ramadan meals may be calorie-dense, water abstention in warm climates may result in dehydration, overeating may occur before bed, and regular sleep patterns may be disturbed [16]. Therefore, the physiological changes associated with Ramadan fasting differ from general, intermittent fasting [17]; the former may have unidentified effects when body functions are disrupted [5,10].…”

Traditional and Medical Applications of Fasting

“…In this context, and pending appropriate trials, Ramadan is likely to be beneficial for healthy individuals. However, it is important to underscore that some patients, for example, diabetics [15,16] should be carefully evaluated by their physicians before undertaking Ramadan. Even though studies on the safety of Ramadan fasting in patients with cardiac disease are scant and there are no randomized trials, some consensus has been reached [17].…”

“…Alternate-day fasting involves the interchange between ad libitum feeding and fasting days, consisting of 0% to 25% of daily caloric needs intake. Time-restricted feeding follows the same eating routine every day: a certain number of hours (16)(17)(18)(19)(20) of fasting and the remaining hours (4)(5)(6) to feed. Whole-day fasting consists of one to two days of complete fasting per week, interchanged with ad libitum eating on the other days [4].…”