By A Staff Reporter -
MUSCAT — Local experts are urging overweight Muslim patients with type 2 diabetes to fast during Ramadhan, citing a range of benefits to be had from the reduced caloric intake.
Ruling out high risk patients such as those with type 1 (or insulin-dependent) diabetes, pregnant women, those that have poor glycaemic (blood sugar) control, and the elderly, Dr Abdul Razzaq al Madani said, many other patients with type 2 diabetes should fast to take advantage of the health benefits associated with fasting — provided they adhere to prescribed medication regimens and do not over-indulge during non-fasting hours.
“Unfortunately many Muslim patients, and Muslims in general, tend to overeat upon breaking their fast, and usually the meal involves heavy, fatty foods that are high in calories,” added Dr Al Madani, Head of Emirates Diabetes Society and CEO of Dubai Hospital.
“Overweight Muslims with diabetes should take advantage of Ramadhan, as excess weight and obesity are closely linked to this disease, and weight reduction leads to improved health — especially in terms of reduced blood sugar levels as well as lower cholesterol levels and reduced blood pressure,” continued Dr Al Madani.
According to Dr Al Madani, patients should follow their medication regimens as prescribed by their doctors, and avoid indulging in fatty foods and sweets.
“Patients should also be testing their blood sugar levels at least twice daily before breaking fast, especially around four in the afternoon, and if below 70 mg/dL, they should immediately break their fast to avoid hypoglycaemia,” he added.
Symptoms of hypoglycaemia include nervousness, sweating, intense hunger, trembling, weakness, palpitations and sufferers often have trouble speaking.
In severe cases people require hospitalisation and it can even lead to coma and death.
More than 50 million Muslim patients with type 2 diabetes choose to fast during Ramadhan.
While fasting is undertaken without long-term health consequences for the majority of the Muslim population, it can have important health consequences for type 2 diabetes patients.
Abstaining from food and drink during daylight hours, followed by subsequent overeating at night, can place type 2 diabetes patients at up to five times more risk of hyperglycemia and as much as seven times more risk of hypoglycemia if not managed properly.
The cost implications of severe hypoglycaemia are also important for healthcare organisations to note, with each hospital admission for a severe event estimated to cost in the UK region of 1,000 British pounds.
Swiss pharmaceutical company Novartis has embarked on an international observational study to compare new modalities of treatment, which include Galvus (vildagliptin) based therapy, with the traditional sulphonylurea therapy.
“We expect to recruit around 700 patients across the Middle East for this study, observing any hypoglycaemic events and weight gain over the Ramadhan period.
“It is important that we gain a deeper understanding of the disease and the side effects of fasting, especially in predominantly Muslim populations like the UAE where prevalence figures for diabetes are staggering,” said Dr Mohamed Ibrahim, Regional Medical Manager for Novartis, Middle East cluster.
A similar, recent study in the UK, published in the Current Medical Research and Opinion journal, investigated the effects of different treatments on diabetes control in 72 Muslims with type 2 diabetes, who were fasting for 11-20 hours per day during the holy month of Ramadhan.
The study found that those taking metformin in combination with vildagliptin experienced no hypoglycaemic episodes during the 16 week study, compared with those who took metformin and sulphonylurea of which more than 40 per cent suffered such an event (4).
Vildagliptin is a DPP-4 inhibitor that works by blocking the breakdown of ‘incretin’ hormones in the body that stimulate the pancreas to produce insulin.
Its mechanism of action targets the dysfunction in the pancreatic islet alpha and beta cells that cause high blood sugar levels in people with type 2 diabetes.