PT - JOURNAL ARTICLE AU - Zheng Kang Lum AU - Zi Rui Khoo AU - Wei Yann See Toh AU - Shaikh Abdul Kader Kamaldeen AU - Abdul Shakoor AU - Keith Yu Kei Tsou AU - Daniel Ek Kwang Chew AU - Rinkoo Dalan AU - Sing Cheer Kwek AU - Noorani Othman AU - Joyce Xia Lian AU - Raden Nurheryany Bte Sunari AU - Joyce Yu-Chia Lee TI - Efficacy and Safety of Use of the Fasting Algorithm for Singaporeans With Type 2 Diabetes (FAST) During Ramadan: A Prospective, Multicenter, Randomized Controlled Trial AID - 10.1370/afm.2500 DP - 2020 Mar 01 TA - The Annals of Family Medicine PG - 139--147 VI - 18 IP - 2 4099 - http://www.annfammed.org/content/18/2/139.short 4100 - http://www.annfammed.org/content/18/2/139.full SO - Ann Fam Med2020 Mar 01; 18 AB - 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 (HbA1c) level ≤9.5%, and intention to fast for ≥10 days during Ramadan. Exclusion criteria included baseline estimated glomerular filtration rate <30 mL/min, diabetes-related hospitalization, and short-term corticosteroid therapy. Participants were randomized to intervention (use of FAST) or control (usual care without FAST) groups. Efficacy outcomes were HbA1c 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 HbA1c 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.