The effect of Ramadan fasting and continuing sodium-glucose co-transporter-2 (SGLT2) inhibitor use on ketonemia, blood pressure and renal function in Muslim patients with type 2 diabetes

Yan-li, Shao; Lim, Gerard Joseph; Chua, Chin Lian; Wong, Y; Yeoh, Ester; Low, Sui Pheng; Sum, Chee Fang

doi:10.1016/j.diabres.2018.05.022

Cited by 43 publications

(50 citation statements)

References 17 publications

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“…Moreover, in our characterisation of biological biomarkers (blood pressure, CRP, glucose levels), we observed that the elderly may receive more benefits from fasting than younger men, due either to the fact elderly are more susceptible to the extreme variations in nutriments intakes, to the longer experience and better management of fasting or simply to the fact they are the at-risk population [33]. Our study also describes the novel effect of fasting on biomarkers associated with physiological functions—such as orexin-A (wakefulness) [34], β-hydroxybutyrate (non-conventional metabolic pathways) [35] and PDGF-AA (aging/senescence) [36].…”

Section: Discussionmentioning

confidence: 99%

Recurrent circadian fasting (RCF) improves blood pressure, biomarkers of cardiometabolic risk and regulates inflammation in men

et al. 2019

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Background The effects of fasting on health in non-human models have been widely publicised for a long time and emerging evidence support the idea that these effects can be applicable to human practice. Methods In an open label longitudinal follow-up, a cohort of 78 adult men (aged 20 to 85 years) who fasted for 29 consecutive days from sunrise to sunset (16 h fasting—referred to as recurrent circadian fasting) in Pakistan, were studied. The primary outcomes of the fasting study was weight loss/recovery and the associated changes in blood pressure and circulating levels of surrogate markers linked to organ and system functions—including cardiovascular, metabolic and inflammation. Post-fasting outcomes include the regulation of physiological biomarkers. Results Recurrent circadian fasting with weight loss reduced blood pressure (140.6 vs. 124.2 mmHg) and markers of cardiovascular risk (~ 4-fold for resistin; triglycerides: p < 0.0001). Reduced glycemia (p < 0.0001) and the associated changes in the regulation of ketosis (β-hydroxybutyrate) were accompanied by a metabolic shift (PPARβ, osteoprotegerin), suggesting the involvement of the different physiological systems tested. Elevated orexin-A levels (p = 0.0183) in participants indicate sleep disturbance and circadian adaptation. All participants had CRP level < 2 mg/l during the fasting period and a similar trend was observed for TNFα. While most SASP molecules were decreased after the fasting period, heightened levels of IL-8 and IL-6 suggest that some inflammatory markers may be elevated by recurrent circadian fasting. Importantly, older adults reveal similar or more substantial benefits from fasting. Conclusions Recurrent circadian fasting is beneficial at the cardiometabolic and inflammatory levels, especially for at-risk individuals—this is contingent on compliance towards the recommended dietary behaviour, which controls carbohydrate and caloric intake. These benefits from fasting may be particularly beneficial to older adults as they often exhibit abnormal cardiovascular, metabolic and inflammatory signatures. Electronic supplementary material The online version of this article (10.1186/s12967-019-2007-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Recurrent circadian fasting (RCF) improves blood pressure, biomarkers of cardiometabolic risk and regulates inflammation in men

et al. 2019

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“…Earlier research also supports the greater risk of hypoglycaemia with SUs compared metformin monotherapy [ 62 ]. A number of studies have also shown the lower risk of hypoglycaemia with newer T2 diabetes therapies compared to SUs and their safety in Ramadan fasting [ 58 , 59 , 63 – 71 ].…”

Section: Specific Risks and Metabolic Parameters In Diabetes In Relatmentioning

confidence: 99%

“…Both groups had a similar change in weight, eGFR, sitting systolic, sitting diastolic blood pressure and plasma β-OHB level. The proportion of patients experiencing at least one hypoglycaemic event during fasting non-significantly increased in the control group and decreased in the study group [ 63 ].…”

Section: Managementmentioning

confidence: 99%

Ramadan and Diabetes: A Narrative Review and Practice Update

et al. 2020

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Fasting in the Islamic month of Ramadan is obligatory for all sane, healthy adult Muslims. The length of the day varies significantly in temperate regions-typically lasting C 18 h during peak summer in the UK. The synodic nature of the Islamic calendar means that Ramadan migrates across all four seasons over an approximately 33-year cycle. Despite valid exemptions, there is an intense desire to fast during this month, even among those who are considered to be at high risk, including many individuals with diabetes mellitus. In this review we explore the current scientific and clinical evidence on fasting in patients with diabetes mellitus, focussing on type 2 diabetes mellitus and type 1 diabetes mellitus, with brief reviews on pregnancy, pancreatic diabetes, bariatric surgery, the elderly population and current practice guidelines. We also make recommendations on the management of diabetes patients during the month of Ramadan.

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“…Finally, in terms of renal function parameters, studies investigating the effect of Ramadan fasting show that there was a significant reduction in serum creatinine, estimated glomerular filtration rate (eGFR) and urinary albumin/creatinine ratio in healthy individuals, but the decline was within the normal range [ 20 ]. In Muslim patients with type 2 diabetes, there was also a significant decrease in eGFR after Ramadan fasting [ 21 ]. In patients with chronic kidney disease (CKD), one study showed that there was an increase in serum creatinine in those who fasted [ 22 ], while no significant change was observed in another study [ 23 ].…”

Section: Changes In Dietary Intakementioning

confidence: 99%

Effects of Time-Restricted Feeding during Ramadan on Dietary Intake, Body Composition and Metabolic Outcomes

Osman¹,

Haldar²,

Henry

2020

Nutrients

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Ramadan fasting is a form of time-restricted feeding which combines a fast and feast period daily for a duration of one month every year. During Ramadan, Muslims abstain from food and drink consumption from dawn till sunset and this change in the meal schedule and frequency results in significant changes to the composition of the diet, such as energy and nutrient intake. These changes in dietary habits and their corresponding effects on cardiometabolic disease risk are compiled in this review. Ramadan fasting shows limited benefits to body composition via reductions in body mass in both healthy and obese individuals, although the results are often found to be transient and heterogeneous. There is, however, a more consistent improvement in blood lipid profile during Ramadan fasting, which often lasts beyond the Ramadan period. The results for glucose homeostasis, on the contrary, are more conflicting and inconclusive. The heterogeneity in the findings from the various studies can be generally attributed to cultural variations in dietary habits, differences in the duration of fasting due to seasonal/climatic differences at various geographical locations, age, gender and socioeconomic status, as well as other health and lifestyle factors of the various study populations.

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The effect of Ramadan fasting and continuing sodium-glucose co-transporter-2 (SGLT2) inhibitor use on ketonemia, blood pressure and renal function in Muslim patients with type 2 diabetes

Cited by 43 publications

References 17 publications

Recurrent circadian fasting (RCF) improves blood pressure, biomarkers of cardiometabolic risk and regulates inflammation in men

Recurrent circadian fasting (RCF) improves blood pressure, biomarkers of cardiometabolic risk and regulates inflammation in men

Ramadan and Diabetes: A Narrative Review and Practice Update

Effects of Time-Restricted Feeding during Ramadan on Dietary Intake, Body Composition and Metabolic Outcomes

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