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.
The 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. The researchers conclude that the use of empowerment-based, tailored tools for diabetes management like FAST can help observant Muslims with diabetes fast safely.
In an accompanying editorial, University of Michigan family physician Jonathan Gabison, MD, argues for the broader clinical implications of protocols like FAST that enable people with medical conditions to fast safely. To avoid hypoglycemic events, Gabison recommends physician supervision for diabetic patients considering fasting as well as another trending practice: low carbohydrate diets. Gabison concludes, "While more research is needed, a protocol to manage diabetes medications safely with intermittent fasting may help keep patients safe while we learn more about the use of these strategies to help combat obesity and diabetes."
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Efficacy and Safety of Use of the Fasting Algorithm for Singaporeans With Type 2 Diabetes (FAST) During Ramadan: A Prospective, Multicenter, Randomized Controlled Trial
Joyce Yu-Chia Lee, PharmD, FCCP, BCPS, BCACP, et al
University of California, Irvine, Susan & Henry Samueli College of Health Sciences, Department of Clinical Pharmacy Practice, Irvine, California
Post-embargo published article link (link is active on March 9, 2020, 5pm Eastern)
http://www.annfammed.org/content/18/2/139
Implications of the FAST Protocol Beyond Spirituality
Jonathan G. Gabison, MD
University of Michigan, Department of Family Medicine, Ann Arbor, Michigan
Post-embargo published article link (link is active on March 9, 2020, 5pm Eastern)
http://www.annfammed.org/content/18/2/98
Journal
The Annals of Family Medicine