Ramadan fasting in people with diabetes and chronic kidney disease (CKD) during the COVID-19 pandemic: The DaR global survey.

BACKGROUND AND AIMS: The DaR Global survey was conducted to observe the impact of the COVID-19 pandemic on the intentions to fast and the outcomes of fasting in people with diabetes and chronic kidney disease (CKD). METHODS: Muslim people with diabetes and CKD were surveyed in 13 countries shortly after the end of Ramadan 2020, using a simple Survey Monkey questionnaire. RESULTS: This survey recruited 6736 people with diabetes, of which 707 (10.49%) had CKD. There were 118 (16.69%) people with type1 diabetes (T1D), and 589 (83.31%) were with type2 diabetes (T2D). 62 (65.24%) people with T1D and 448 (76.06%) people with T2D had fasted with CKD. Episodes of hypoglycaemia and hyperglycaemia were more frequent among people with T1D compared to T2D, 64.52% and 43.54% vs 25.22% and 22.32% respectively. Visits to the emergency department and hospitalization were more frequent among people with CKD, however no significant difference was found between people with T1D and T2D. CONCLUSION: The COVID-19 pandemic had only a minor effect on the intention to fast during Ramadan in people with diabetes and CKD. However, hypoglycaemia and hyperglycaemia were found to be more frequent, as well as emergency visits and hospital admissions among people with diabetic kidney disease. Prospective studies are needed in future to evaluate the risk indicators of hypoglycaemia and hyperglycaemia among fasting people with CKD, especially in the context of different stages of kidney disease.

Efficacy and safety of empagliflozin in people with type 2 diabetes during Ramadan fasting.

BACKGROUND AND AIMS: To explore efficacy and safety of empagliflozin in people with type2 diabetes during Ramadan fasting METHODS: People with type2 diabetes (T2DM) who were taking empagliflozin and sulphonylurea with or without a metformin and dipeptidyl peptidase inhibitors (DPP4) recruited a month before Ramadan. Glycated hemoglobin (HbA1c) and estimated glomerular filtration rate (eGFR) were recorded pre- and post-Ramadan. A predesigned diary was given to the participants to keep track of their T2DM status during Ramadan. The proportion of the people who had hypoglycaemia, or any adverse event related to the study drug was assessed after-Ramadan. RESULTS: A total of 116 participants completed the study. Symptomatic episodes of hypoglycaemia were more common among people who used sulphonylurea (i.e., 8.6%). Genitourinary infections and volume depletion events were recorded more in people on empagliflozin i.e., (6.9% and 5.17%, respectively). A significant reduction in body mass index (BMI), and HbA1c was noted among people on empagliflozin post Ramadan. A significant reduction in eGFR was noted only in people who were taking empagliflozin in combination with metformin. CONCLUSION: Empagliflozin was found to be safe and effective in fasting people with T2DM. Further large-scale studies are needed to validate our findings.

Effect of Ramadan fasting on renal function of people with diabetes; a prospective longitudinal study.

AIM: To observe the effect of Ramadan fasting on renal function of people with diabetes. METHODS: This prospective, observational, and longitudinal study was conducted at Baqai Institute of Diabetology and Endocrinology, between April-July 2019. People with type2 diabetes mellitus were recruited using convenient sampling. Demographic data along with renal function were recorded before Ramadan. Kidney functions were assessed in those who came for follow up at 6 weeks, 3 months, and a year after Ramadan. RESULTS: A total of seventy people with diabetes participated in this study with the mean age of 53.11 ± 8.70 years. A significant decline in eGFR was noted around six weeks post Ramadan with a significant improvement of eGFR at 3 months follow-up. The normalization of kidney functions among the study participants was observed even after one year of Ramadan. CONCLUSION: In this study post Ramadan assessment of creatinine clearance showed a significant fall among fasting people with diabetes though remained with in normal limits. Significant improvement and reversal of kidney functions was noted in those who followed within three months' time.

To explore the association of Ramadan fasting with symptoms of depression, anxiety, and stress in people with diabetes.

AIM: To explore the association of Ramadan fasting with symptoms of depression, anxiety, and stress in people with diabetes. METHODS: This observational study was conducted at Baqai Institute of Diabetology and Endocrinology between May-July 2017. Informed consent was taken from each study participant. Demographic and baseline data was recorded. DASS-21 scale was used to assess symptoms of depression, anxiety, and stress pre and post Ramadan. RESULTS: A total of one hundred and fifty people with diabetes participated in this study. 100 people were in fasting group and 50 were in non-fasting group. In fasting group pre-Ramadan depression, anxiety and stress symptoms were present in 45%, 45%,49% of people which improved to 23%, 26%, 35% post Ramadan (p-value <0.0001, <0.0001, 0.001) respectively. In non-fasting group pre-Ramadan depression and anxiety symptoms were present in 34%, and 50% of people, which improved to 30% and 40% post Ramadan (p-value 0.625, 0.227) respectively, while no improvement was observed in stress symptoms. CONCLUSION: There is significant improvement in symptoms of depression, anxiety, and stress in people with diabetes post-Ramadan fasting.