Risk Stratification in People with Diabetes for Fasting During Ramadan: Consensus from Arabic Association for the Study of Diabetes and Metabolism.

BACKGROUND: Current international guidelines recommend a pre-Ramadan risk assessment for people with diabetes (PwDM) who plan on fasting during the Holy month. However, a comprehensive risk assessment-based recommendation for the management of PwDM intending to fast is still controversial. Therefore, the Arabic Association for the Study of Diabetes and Metabolism (AASD) developed this consensus to provide further insights into risk stratification in PwDM intending to fast during Ramadan. METHODS: The present consensus was based on the three-step modified Delphi method. The modified Delphi method is based on a series of voting rounds and in-between meetings of the expert panel to reach agreements on the statements that did not reach the consensus level during voting. The panel group comprised professors and consultants in endocrinology (both adult and pediatric). Other members included experts in the fields of cardiovascular medicine, nephrology, ophthalmology, and vascular surgery, affiliated with academic institutions in Egypt. RESULT: In PwDM who intend to fast during Ramadan, risk stratification is crucial to optimize patient outcomes and prevent serious complications. The present consensus provides risk assessment of those living with diabetes according to several factors, including the type of diabetes, presence, and severity of complications, number of fasting hours, and other socioeconomic factors. According to their risk factors, patients were classified into four categories (very high, high, moderate, and low risk). CONCLUSION: Future research is warranted due to the controversial literature regarding the impact of fasting on certain comorbidities.

The Association of Vitamin K2 Level with the Glycaemic Status in Type 2 Diabetic Patients: A Case-Control Study.

Objectives: The target of this work was to investigate vitamin K2 level link to glycaemic status in type 2 diabetes mellitus (T2DM) patients. Methodology: Sixty T2DM patients were divided into 30 uncontrolled T2DM (group I), 30 controlled T2DM (group II) patients and 30 non-diabetic subjects as the control group. Vitamin K2 level, fasting insulin, homeostasis model assessment insulin resistance (HOMA-IR), fasting blood glucose (FBG), 2-h postprandial blood glucose (PPG), glycosylated haemoglobin (HbA1c) and fasting lipids were documented. Waist circumference (WC) was measured and body mass index (BMI) was calculated. Results: A highly significant difference between groups was observed in vitamin K2 level (P < 0.001) being 1.61 ± 0.56 ng/ml, 2.04 ± 0.59 ng/ml and 2.96 ± 0.82 ng/ml for groups I, II and III, respectively. Among diabetics, a negative correlation was reported between serum vitamin K2 and FBG (r -0.428), 2-h PPBG (r -0.319), HbA1c (r -0.268), fasting insulin (r -0.49), HOMA-IR (r -0.5), total cholesterol (T-cholesterol) (r -0.335) and LDL-C (r -0.296) with P < 0.05. The receiver operating characteristic (ROC) curve emphasized the utility of the discriminated potentiality of serum vitamin K2 as a biomarker for uncontrolled hyperglycaemia in T2DM. The multivariate linear regression has shown that FBG is the only significant independent predictor of serum levels of vitamin K2. Conclusions: In T2DM patients, serum vitamin K2 level was significantly lower, especially with uncontrolled hyperglycaemia. This suggests that vitamin K2 level has an association with the glycaemic status in T2DM.

Culturally based pre-Ramadan education increased benefits and reduced hazards of Ramadan fasting for type 2 diabetic patients.

OBJECTIVES: In the current study, we aimed at evaluating the effect of a culturally-based pre-Ramadan education program (PREP) on glycemic control, weight, adherence to post-sunset physical activity, perception of hypoglycemia, and anti-diabetic medication dose adjustment during Ramadan fasting in type 2 diabetics. STUDY DESIGN: A total of 1008 type 2 Diabetes patients were offered a culturally-based PREP in addition to the standard of care, two months before Ramadan. A retrospective interview one month after Ramadan compared the fasting experience of PREP attendees (470 patients) with those who merely received standard of care (538 patients) (Non-PREP). RESULTS: Ramadan fasting improved glycemic control with a correlation between HbA1c percent reduction and the number of fasting days (r = -0.290, p = 0.007). More HbA1c and weight percent reduction were observed in PREP attendees compared to the Non-PREP group (-14.8% ± 9.3 vs. -5.4% ± 5.4; p < 0.001; and - 1.96% ± 5.4 vs. -0.39% ± 2.8; p < 0.001, respectively). More commitment to night prayers in the PREP attendees compared to the Non-PREP group, (85.5% prayed >20 nights vs 28.4%; p < 0.001) with more HbA1c and weight percent reduction in the those who performed the prayers more than 20 nights compared to those who performed no prayers (-11.69% ± 8.8 vs -6.28% ± 6.4, p < 0.001; and - 2.76% ±5.1 vs 1.35% ±1.8, p < 0.001, respectively). More perception of true hypoglycemia was associated with PREP attendance (p0.046), insulin treatment (p0.000), and reduction of antidiabetic medication dosage (p0.004). Repeated lowering of antidiabetic medications doses with sequential downsizing of meals' portions, and appetite was reported. CONCLUSION: Ramadan fasting was beneficial for people with type 2 diabetes with reduction of HbA1c in correlation with the number of fasting days. Contrasting PREP with Non-PREP participants discovered better HbA1c and weight reduction in the former group even with equal number of fasting days. PREP participants performed more Taraweeh night prayers. The more the prayer nights the more decline of HbA1c and weight was observed. PREP improved perception and response to hypoglycemia with low-dosing of antidiabetic medications, especially insulin.

Serum omentin-1 levels in type 2 diabetic obese women in relation to glycemic control, insulin resistance and metabolic parameters.

BACKGROUND: Omentin-1 a new anti-inflammatory adipokine has been identified as a major visceral (omental) secretory adipokine which plays important roles in glucose homeostasis, lipid metabolism, insulin resistance and diabetes. The aim of our study was to evaluate serum omentin-1 levels in type 2 diabetic obese females and assess its relation with glycemic control, insulin resistance and metabolic parameters. METHODS: The study included 60 obese type 2 diabetic females and 30 healthy female subjects formed the control group. They subjected to full clinical examination, weight, height, waist and hip circumference. Fasting (blood glucose, insulin, lipid profile, omentin-1) and HbA1c were measured. BMI and HOMA-IR were calculated. Our data analyzed and expressed in terms of mean ±â€¯SD. Pearson correlation performed to study the correlation of serum omentin-1 in relation to glycemic control, insulin resistance and metabolic parameters in the studied groups. RESULTS: We found significant decrease in serum omentin-1 levels in cases with mean ±â€¯SD (16.5 ±â€¯2.6 pg/ml) compared to controls (25.3 ±â€¯1.0 pg/ml) (P < 0.001). We also found strong significant negative correlations between serum omentin-1 and (BMI, fasting insulin, HOMA-IR) (r = -0.909, -0.853, -0.511) respectively (P < 0.001) and systolic blood pressure (r = -0.274, p = 0.031). The best cut off point of serum omentin-1 was 22.2 pg/ml to differentiate cases from controls using ROC curve analysis. CONCLUSION: Our study has shown significant low levels of serum omentin-1 in obese type 2 diabetic females in comparison to healthy subjects. Omentin-1 inversely related to obesity, insulin resistance and SBP. No significant associations with glycemic control and fasting lipids. Serum omentin-1 can be used as a biomarker for obesity related metabolic disorders.