Department of Nutrition and Food Technology, Faculty of Agriculture, The University of Jordan, Amman, Jordan.
Department of Clinical Nutrition and Dietetics, College of Health Sciences/Research Institute for Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates.
Front Endocrinol (Lausanne). 2021 Mar 8;12:624423. doi: 10.3389/fendo.2021.624423. eCollection 2021.
Ramadan is the 9th month of the lunar calendar during which Muslims abstain from food and drink between dawn and sunset for 30 consecutive days. Ramadan fasting is observed by all healthy Muslim adults, as well many Muslims with type 2 diabetes (T2DM). Hypoglycemic events (HE) are a serious complication associated with diabetes management and are associated with increased cardiovascular disease risk. Conflicting results have been reported concerning the incidence of HE among people with T2DM observing Ramadan fasting. This review summarizes available scientific evidence on the occurrence of HE and the effects of different moderators on the incidence of HE among patients with T2DM during Ramadan. We conducted a systematic review of available observational studies and randomized controlled trials (RCTs) for patients with T2DM who fasted during Ramadan, with HE as the primary outcome. Ten databases were searched for relevant studies from inception until October 31, 2020. In total, 68 studies (35 RCTs and 33 observational studies) met the inclusion criteria. Non-sulfonylureas hypoglycemic medications showed superior effects in lowering the incidence of HE over sulfonylureas hypoglycemic medications. Variable moderators were associated with experiencing HE during Ramadan in both observational studies and RCTs, including sex, geographical location, body anthropometric indicators, season, dietary behaviors, fasting duration, time since diagnosis, and pre-fasting education. This comprehensive systematic review covered the largest number of observational and clinical studies investigating the impact of Ramadan on HE among patients with T2DM. The study highlights the significance of different moderators that influence the effect of Ramadan fasting on HE, including dietary behaviors, fasting time duration, sex, season, country, pre-fasting education, age, and time since diagnosis. The study also highlighted the impact of different hypoglycemic medications on HE and noted the superiority of non-sulfonylureas over sulfonylureas hypoglycemic medications in lowering the risk for hypoglycemia in people with T2DM during Ramadan fasting.
斋月是伊斯兰教历的第九个月，在这一个月里，穆斯林从黎明到日落期间要禁食和饮水，连续 30 天。所有健康的成年穆斯林以及许多患有 2 型糖尿病（T2DM）的穆斯林都会遵守斋月禁食。低血糖事件（HE）是与糖尿病管理相关的严重并发症，与心血管疾病风险增加有关。关于在遵守斋月禁食的 T2DM 人群中 HE 的发生率，已有报道结果相互矛盾。本综述总结了目前关于 T2DM 患者在斋月期间发生 HE 以及不同调节因素对 HE 发生率影响的可用科学证据。我们对在斋月期间禁食的 T2DM 患者进行了系统的观察性研究和随机对照试验（RCT）的综述，以 HE 为主要结局。从研究开始到 2020 年 10 月 31 日，我们在 10 个数据库中搜索了相关研究。共有 68 项研究（35 项 RCT 和 33 项观察性研究）符合纳入标准。非磺酰脲类降糖药物在降低 HE 发生率方面的效果优于磺酰脲类降糖药物。在观察性研究和 RCT 中，不同的调节因素与在斋月期间发生 HE 有关，包括性别、地理位置、人体测量指标、季节、饮食行为、禁食时间、诊断后时间以及预禁食教育。本综述涵盖了数量最多的观察性和临床研究，探讨了斋月对 T2DM 患者 HE 的影响。研究强调了不同调节因素的重要性，这些因素影响了斋月禁食对 HE 的影响，包括饮食行为、禁食时间、性别、季节、国家、预禁食教育、年龄和诊断后时间。该研究还强调了不同降糖药物对 HE 的影响，并指出在斋月禁食期间，非磺酰脲类降糖药物比磺酰脲类降糖药物在降低 T2DM 患者低血糖风险方面更具优势。
