The impact of Ramadan fasting on metabolic profile among type 2 diabetes mellitus patients: A meta-analysis

Background and aims: Majority of Muslims with type 2 diabetes mellitus (T2DM) fasted during Ramadan regardless of possible risk of complication. This systematic review aims to assess the impact of Ramadan fasting on metabolic profile and hypoglycemia event among T2DM patients. Methods: Literature searching was conducted on December 2019 at PUBMED, Medline (EBSCOhost), and ProQuest databases using the following keywords: Ramadan fasting, type 2 diabetes mellitus, glycemic and lipid profile, anthropometry measurements, and hypoglycemia. Observational studies in adults and published in English which analyze the glucose parameters, lipid profile, and hypoglycemia among T2DM patients during Ramadan were included in the analysis. All studies were assessed for its risk of bias using New-Castle Ottawa Scale. The heterogeneity of the studies was analyzed using I² (square) test and the overall mean difference between studied parameters before and after Ramadan fasting was calculated using Weighted Mean Difference (WMD) test using Stata 13. Results: A total of 28 observational studies that were conducted in Middle Eastern, African, and Asian countries were included. This review found decrease in FPG level by −15.28 (95% CI -17.22, −13.34) mg/dl, HbA1c by −0.27 (95% CI -0.32, −0.22)%, total cholesterol by −12.88 (95% CI -14.68, −11.09) mg/dL, LDL-C by −4.42 (95% CI -6.17, −2.66)mg/dl, HDL-C by −1.09 (95% CI -1.71 – 0.47) mg/dL, triglyceride by −2.47 (95% CI -3.69 – 1.24) mg/dL and decreased anthropometry measurement. No studies reported fatal hypoglycemia event. Conclusions: Ramadan fasting resulted in slight improvement of overall metabolic profile and anthropometry among T2DM patients with relatively low incidence of hypoglycemia.