Article Figures & Data
Figures
- Figure 1
Flow diagram for trial participants.
- Figure 2
Trends of change in mean HbA1c level across pre-Ramadan, post-Ramadan, and 3-month follow-up timepoints.
- Figure 3a
Trends of change in mean FBG levels across pre-Ramadan, post-Ramadan, and 3-month follow-up timepoints.
ADA = American Diabetes Association; FBG = fasting blood glucose; PPG = postprandial glucose
Changes in fasting blood glucose during the Ramadan period. The dotted line indicates the target cutoff for fasting blood glucose of 130 mg/dL, as defined by the ADA.
- Figure 3b
Trends of change in mean PPG levels across pre-Ramadan, post-Ramadan, and 3-month follow-up timepoints.
ADA = American Diabetes Association; FBG = fasting blood glucose; PPG = postprandial glucose
Changes in postprandial glucose during the Ramadan period. The dotted line indicates the target cutoff for postprandial glucose of 180 mg/dL, as defined by the ADA.
Tables
Characteristic Overall (N = 97)a Intervention Group (n = 46)a Control Group (n = 51)a P Value Age, y, mean (SD) 59.5 (11.2) 59.8 (10.8) 59.3 (11.7) .811 Sex, No. (%) .022 Male 39 (40.2) 24 (52.2) 15 (29.4) Female 58 (59.8) 22 (47.8) 36 (70.6) Ethnicity, No. (%) .440 Malay 88 (90.7) 43 (93.5) 45 (88.2) Indian 6 (6.2) 2 (4.3) 4 (7.8) Chinese 1 (1.0) 1 (2.2) 0 (0) Other 2 (2.1) 0 (0) 2 (3.9) Education level, No. (%) .282 No formal education 4 (4.1) 1 (2.2) 3 (5.9) Elementary 29 (29.9) 13 (28.3) 16 (31.4) High school 43 (44.3) 20 (43.5) 23 (45.1) College/university 21 (21.6) 12 (26.1) 9 (17.6) Days fasted during Ramadan, median (IQR) 30 (26-30) 30 (27-30) 30 (26-30) .896 Duration of diabetes, y, median (IQR) 10 (5.0-20.0) 10 (5.0-15.0) 11 (4.5-21.5) .529 Number of comorbidities, mean (SD) 3.75 (1.24) 3.72 (1.24) 3.78 (1.25) .793 Diabetes regimen, No. (%) .084 Insulin only 2 (2.1) 2 (4.3) 0 (0) Oral therapy only 59 (60.8) 31 (67.4) 28 (54.9) Insulin and oral therapy 36 (37.1) 13 (28.3) 23 (45.1) BMI, kg/m2, mean (SD) 30.3 (5.5) 29.7 (5.6) 30.8 (5.4) .352 HbA1c, mean (SD) .932 % 7.8 (0.9) 7.8 (0.9) 7.8 (0.9) mmol/mol 62 (9.9) 62 (9.9) 62 (9.9) Fasting blood glucose, mg/dL, mean (SD) 120.8 (28.9) 123.7 (27.1) 118.6 (32.5) .283 Postprandial glucose, mg/dL, mean (SD) 196.4 (55.9) 191.0 (41.5) 201.8 (68.5) .867 Creatinine clearance, mL/min, mean (SD) 60.3 (29.6) 58.8 (30.1) 61.7 (29.4) .635 BMI = body mass index; HbA1c = glycated hemoglobin; IQR = interquartile range.
↵a Data are presented as number (%) for categoric variables, mean (SD) for normally distributed continuous variables, and median (IQR) for nonnormally distributed continuous variables.
Intervention Group (n = 46) Control Group (n = 51) P Value Self-reported minor hypoglycemia eventa, No. (%) 14 (30.4) 15 (29.4) .912 Minor hypoglycemia event based solely on SMBG reading <72 mg/dL, No. (%) 4 (8.7) 6 (11.8) .744 Actual minor hypoglycemia eventb, No. (%) 1 (2.2) 5 (9.8) .154 SMBG = self-monitoring of blood glucose.
↵a Minor hypoglycemia event defined as signs and symptoms precipitated by known or modifiable causes and could be quickly self-managed with or without ingesting fast-acting glucose.
↵b Actual minor hypoglycemia event defined as self-reported minor hypoglycemia and a corresponding objective SMBG reading of <72 mg/dL.
The Article in Brief
Efficacy and Safety of Use of the Fasting Algorithm for Singaporeans With Type 2 Diabetes (FAST) During Ramadan: A Prospective, Multicenter, Randomized Controlled Trial
, and colleagues
Background Most Muslims who have diabetes engage in intermittent fasting during Ramadan, yet there are concerns regarding how to safely manage diabetes while fasting. A study of fasting adults with type 2 diabetes found that those who managed their condition in collaboration with their health care provider using an empowerment-based approach, saw greater improvements in glycemic control. Health researchers from the University of California, Irvine and the National University of Singapore developed a collaborative diabetes management tool tailored for fasting Muslims and their doctors called FAST, or "Fasting Algorithm for Singaporeans with Type 2 Diabetes." The FAST tool sought to empower diabetic patients who fast with Ramadan-specific educational materials, dosing modification information for patients and their doctors, and encouragement of active self-monitoring of blood glucose before, during and after fasting.
What This Study Found The FAST tool was evaluated for safety and effectiveness in a prospective, multi-center, randomized controlled trial with 111 fasting adults with type two diabetes in Singapore. Additionally, the FAST protocol did not increase the risk of hypoglycemic events. On average, those in the FAST intervention group showed four times the reduction in hemoglobin A1c compared to the control group (-0.4% vs -0.1%, 95% CI: -0.605 to - 0.001, p = 0.049), in measures taken before and after the fasting period. There were no major hypoglycemic events in either group, and no increase in minor hypoglycemic events in the FAST group.
Implications
- The researchers conclude that the use of empowerment-based, tailored tools for diabetes management like FAST can help observant Muslims with diabetes fast safely. According to the lead author, "This is one of the first tools that brings together Ramadan education, guidance for health care providers and elements of patient empowerment, which can be incorporated into standard practice guidelines and resulting in a global paradigm shift for diabetes management among Muslims who fast during Ramadan."
Supplemental PDF: Fasting Algorithm Flow Chart
Supplemental Appendix
Files in this Data Supplement:
Author audio interview
Editor in Chief Caroline Richardson, MD chats with author Joyce Lee on religion and diabetes, and how her algorithm can support diabetic patients who fast during Ramadan.
Files in this Data Supplement:
- Audio interview with author - .mp3 file
