Haraj Nassim Essabah, Harouna Malam Brah Nana Aichatou, Elaziz Siham, Chadli Asma
Department of Endocrinology and Metabolic Diseases, Ibn Rochd University Hospital, Casablanca, MAR.
Laboratory of Neurosciences and Mental Health, Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, MAR.
Cureus. 2024 Oct 30;16(10):e72710. doi: 10.7759/cureus.72710. eCollection 2024 Oct.
Ramadan presents challenges for patients with type 2 diabetes mellitus (T2DM) who choose to fast. Maintaining good glycemic control through regular monitoring during fasting is crucial. This study aims to evaluate and compare glycemic fluctuations in fasting and non-fasting T2DM patients during Ramadan.
We conducted a prospective comparative study on 39 T2DM patients, divided into fasting and non-fasting groups based on the International Diabetes Federation - Diabetes and Ramadan Alliance (IDF-DAR) Practical Guidelines 2021. Each patient wore an iPro®2 Continuous Glucose Monitoring System (CGMS) device (Medtronic plc, Dublin, Ireland), for five to seven days, with consultations scheduled before, during, and after Ramadan. Glycated hemoglobin (HbA1c) levels were measured before and after Ramadan. The fasting risk score was calculated using the DAR guidelines.
The fasting group included 29 fasting patients with an average fasting risk score of 2.7 according to the DAR guidelines, while the non-fasting group had 10 non-fasting patients with an average score of 6.55. The average HbA1c was estimated by the CGMS at 7.36% for fasting patients and 7.1% for non-fasting patients. In the fasting group, 80% of patients experienced at least one episode of hyperglycemia, averaging 4.03 episodes per day, predominantly occurring during pre-dawn (suhoor) and post-sunset (iftar) periods. Hypoglycemia occurred in 24% of fasting patients, mainly before iftar. In contrast, the non-fasting group had a higher average of 6.8 hyperglycemic episodes per day, with 50% of the group also experiencing hypoglycemia. Notably, a significant improvement in HbA1c was observed in the non-fasting group after Ramadan (7.77 ± 0.89 vs. 9.13 ± 1.99, p=0.037). No significant changes in HbA1c, weight, or body mass index were found in the fasting group.
Pre-Ramadan education, risk stratification, and continuous monitoring during Ramadan are essential to prevent metabolic complications in T2DM patients, whether fasting or non-fasting. CGMSs reveal a high prevalence of hyperglycemia, especially in non-fasting patients, underscoring the need for tailored treatment adjustments to achieve optimal glycemic control.
斋月对选择禁食的2型糖尿病（T2DM）患者构成挑战。在禁食期间通过定期监测维持良好的血糖控制至关重要。本研究旨在评估和比较斋月期间禁食和非禁食T2DM患者的血糖波动情况。
我们对39例T2DM患者进行了一项前瞻性比较研究，根据国际糖尿病联盟 - 糖尿病与斋月联盟（IDF - DAR）2021年实用指南将患者分为禁食组和非禁食组。每位患者佩戴iPro®2连续血糖监测系统（CGMS）设备（美敦力公司，爱尔兰都柏林）5至7天，在斋月前、期间和之后安排会诊。在斋月前后测量糖化血红蛋白（HbA1c）水平。使用DAR指南计算禁食风险评分。
禁食组包括29例禁食患者，根据DAR指南，平均禁食风险评分为2.7，而非禁食组有10例非禁食患者，平均评分为6.55。CGMS估计禁食患者的平均HbA1c为7.36%，非禁食患者为7.1%。在禁食组中，80%的患者至少经历一次高血糖发作，平均每天4.03次发作，主要发生在黎明前（封斋饭）和日落后（开斋饭）时段。24%的禁食患者发生低血糖，主要发生在开斋饭前。相比之下，非禁食组平均每天有6.8次高血糖发作，该组50%的患者也经历过低血糖。值得注意的是，斋月后非禁食组的HbA1c有显著改善（7.77±0.89 vs. 9.13±1.99，p = 0.037）。禁食组的HbA1c、体重或体重指数没有显著变化。
斋月前的教育、风险分层以及斋月期间的持续监测对于预防T2DM患者（无论禁食与否）的代谢并发症至关重要。CGMS显示高血糖的患病率很高，尤其是在非禁食患者中，这突出了需要进行量身定制的治疗调整以实现最佳血糖控制。
