Endocrine Abstracts

Introduction: Ramadan fasting may alter fuel metabolism and energy expenditure by inducing changes in the meal timing, sleep–wake patterns and physical activity. It could affect blood glucose through disrupting energy balance. Evaluation of resting energy expenditure (REE) could help to recommend best nutrition advices to diabetics for maintaining acceptable metabolic control.

Methods: Thirteen type 2 diabetics who were fasted in Ramadan were compared with 18 non fasting patients and 15 fasted healthy volunteers. Well controlled diabetics were allowed and uncontrolled patients were advised to avoid fasting. REE, body mass index (BMI), HbA1c and fructosamine were measured in the first and last week of Ramadan and one week later. REE decreased significantly in all three groups during Ramadan. (13.5% (P=0.002), 10.2% (P=0.007) and 9.5% (P=0.007) in fasting and non fasting diabetics and fasting healthy subjects respectively). HbA1c and fructosamine decreased significantly in non fasting diabetics (P=0.008), because baseline HbA1c was higher in this group. Since HbA1c was in acceptable range in fasting diabetics, it didn’t change significantly. BMI did not change significantly in any of the groups.

Conclusion: Ramadan fasting reduces REE, and this reduction in diabetic and healthy subjects is merely a consequence of fasting itself and is not affected by BMI or HbA1c changes. REE reduction in non fasting diabetic patients may be the result of close supervision during study and lifestyle changes brought about by alterations in everyday life of people in Ramadan. So, reduced REE may call for specific diet plans for diabetic patients who are willing to fast, and still maintain good metabolic control during Ramadan.

Keywords: Diabetes Mellitus, Resting Energy Expenditure, Ramadan Fasting, blood glucose, HbA1c.