Background: Ramadan holy month fasting is part of Muslims faith that involves abstaining from food and drink intake as well as oral and injected medications from the dawn to dusk. An appreciable percent of type 1 diabetic patients insists on Ramadan fasting though exempted religiosly and medically.
Objective: To evaluate the effect of Ramadan fasting primarily on eGFR and microalbuminuria in people with type 1 diabetes and secondarily on neuropathy and retinopathy.
Patients and Methods: This study was conducted on 60 type 1 diabetic patients with microalbuminuria intending to fast Ramadan. Patients were recruited from diabetes outpatient clinics at Ain Shams University; all patients were on mutiple daily insulin injection (MDI). Before and after Ramadan fasting blood glucose (FBG), 2hPPBG, HbA1c%, fructosamine, Serum creatinine, BUN, urinary albumin/creatinine ratio (UAC ratio) and estimated GFR were measured to all patients in addition to fundus examination and DN4 questionnaire.
Results: Among 60 patients who joined the study, 53 patients completed the study visits. The end of Ramadan fasting follow up showed a significant rise of serum creatinine and UAC ratio (0.87±0.14 vs 0.93±0.16 mg/dl, p=0.003; 125.5±101.1 vs 132.7±107.8 ugm/mg creatinine, p=0.003), while systolic and diastolic blood pressure showed no significant change (p=0.56; 0.58 respectively). Fifty percent of the patients exhibited a significant decrease of eGFR after Ramadan fasting (96.3±21.5 vs 89.7±22.7 ml/min/1.73 m2, p= 0.002). There was no difference across all studied variables upon subgrouping of patients according to eGFR state (Decreased, stationary and increased). There was a significant improvement of glycemic parameters, FBS (p < 0.001), post-prandial blood sugar (PPBS) (p < 0.001) and fructosamine (p= 0.02) with a significant reduction in hypoglycemic attacks by the end of Ramadan.
Conclusion: Ramadan fasting decreased eGFR but within normal range among 50% of the studied population with a significant increase of UAC ratio inspite of improved glycemia.