The Effect of Ramadan Fasting on Controlling the Lipid, Glucose and Hypoglycemia in the Diabetic Patients under Treatment with Metformin

Document Type : Original Article


1 Health Research Institution, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

2 Nutrition and Metabolic Disease Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.


Background and Objective: The aim of this study was to determine glucose, lipids and the number of hypoglycemia episodes in the patients with type2 diabetes previously treated with metformin while fasting during the month of Ramadan.
Subjects and Methods: A month before Ramadan, 30 patients with type-2 diabetes eligible for inclusion who were under treatment with metformin with or without a combination of glutazone and acarbose entered the study. An individual questionnaire was completed and patients were advised to note their experience of any hypoglycemic episodes during Ramadan fasting. Blood samples were collected, 4 days before and after Ramadan for measurement of blood glucose (FBS), glycated hemoglobin (HbA1C), lipoprotein, fructosamine, low-density cholesterol (LDL), high-density(HDL) lipoprotein, and the triglycerides serum concentrations. Similarly weight, BMI, blood pressure, and diastolic and systolic blood pressure were determined.
Results:  Out of a total of 30 subjects of the study group, 9 (30%) people were men and 21 (70%) women. Except for 1person, 29 people fasted the whole month.The average age was 52.6+8.2 yr (ranged 37-65yr). The average weight before and after Ramadan were 68.2+10 Kg and 67.6+10.2 Kg (P =0.04). Changes of BMI, FBS, HbA1C, total cholesterol, fructosamine, triglycerides, LDL cholesterol, HDL cholesterol and the average diastolic and systolic blood pressure were not significant. Non-severe hypoglycemia was reported in 3cases.
Conclusion: Ramadan fasting does not have a significant effect on the lipid and glycemic control in the patients treated with metformin. Severe hypoglycemia during fasting was not seen but it should be considered as a complication.


1-The Holy Koran. Surah al-Baqarah 2: verses 183-185.
2-Salti I, Be'nard E, Detournay B, Bianchi-BiscayM, LeBrigandc, voinetc , "etal". An EPIDIAR Study group. Apopulation based study of diabetes and its characteristics during the fasting month of Ramadan in 13 conutries:  Results of the Epidemiology of Dia betes and Ramadan 1422/2001(EPIDIAR) Study. Diabetes care 2004;   27:2306-2311.
3-Azizi F. Islamic Fasting and health. Ann Nutr Metab 2010; 56: 273-282.
4-Bolens , Feldmanl , vassy J, WILSONL , Xeh HC, Marinopouloss, "etal". Systematic review: comparative effectiveness and safety of oral medications for type 2 diabetes mellitus. Ann Intern Med 2007; 147: 586-99.
5-Allain CC, Poon LS, Chan CSG, Richmond W, Fu PC.Enzymatic determination of total serum cholesterol. Clinical Chemistry 1974; 28: 412-9.
6-Bucolo G, David H, Quanitative determination of serum triglycerides by use of enzymes. Clinical Chemistry 1973; 19: 476-82.
7-Friedwald WT, Levy RI, Fredrickson DS. Estimation of the concentration of Low-density Lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge. Clinical Chemistry 1972; 18: 499-502.
8-Melmed S, Polonsky KS, Larsen, PR, Kronenberg HM. Williams Textbook of Endocrinology.12th ed.Philadelphia: Elsevier sunders; 2007. P.1410‏.
9-Sari R, Balci MK, Akbas SH, AvciB. The effects of diet, sulfonylurea and repaglinide therapy on clinical and metabolic parameters in type 2 diabetic patients during Ramadan. Endocrine Research 2004; 30(2):169-77.
10-M'guil M, Ragala MA, El Guessabi L, Fellat S, Chraibi A, Chabraoui L, "et al".Is Ramadan fasting safe in type 2 diabetic patients? Clin Exp Hypertens 2008; 30(5): 39-57.
11-Uysal AR, Erdogan MF, Sahin G, Kamel N, Erodogan G. Clinical and metabolic effects of fasting in 41 type 2 potients during ramadan. Diabetes Care 1998; 21: 2033-4.  
12-Klocker N. Ramadan And The Infiuence Of Body Weight On Metabolic Parameters In Fasting NIDDM Patients. Proceedings Of The First International Congress On Health And Ramadan. Casablanca: Hassan II Foundation For Scientifiuc And Medical Research On Ramadan, 1994; 184-188
13-Mafauzy M. Mohammed WB, Anum MY, ZulkifliA, Ruhani AH. A study of the fasting
diabetic Patients during the month of Ramandan. Med J Malaysia 1990; 45(1): 14-7.
14-Yarahmadi Sh, Larijani B, Bastanhagh MH, Pajouhi M, Baradar Jalili R, Zahedi F,"et al". Metabolic And Clinical Effects Of Ramadan Fasting In Patients With Type II Diabetes. J Coll Physicians Surg Pak 2003 Jun; 13(6): 329-32.
15-Laajam MA. Ramadan fasting and non-insuling-dependent diabetes: effect on metabolic control. East Afr Med J 1990; 67(10): 732-6.
16-Belkahdir J, Ghomari H, Klocker N, Mikou A, NasciriM, Sabrim. Muslims with non-insulin dependent diabetes fasting during Ramadan: treatment with glibenclamide. BMJ 1993; 307: 292-295.
17-Katibi La , Akande AA, Bojuwoye BJ, Okesina AB. Blood suger control among fasting Muslims with type 2 diabetes mellitus in IIorin. Niger J Med 2001; 10(3): 132-4.
18-Bouguerra R, Jabrane J, Maatki C, Ben Saleml, Hamzaoui J, Maatki C. Ramadan fasting in type 2 diabetes mellitus. Ann Endocrinol (paris) 2006; 67(1): 54-9.
19-Mafauzy M. Repaglinide versus gliben clamide treatment of type 2 diabetes during Ramadan fasting. Diabets Res clin pract 2002; 58(1): 45-53.
20-AnwarA, Azmi KN, Hamidon BB, khalid BA. An open Label comparative Study of glimepiride versus repaglinide in type 2 diabetes mellitus Muslim subjects during the month of Ramadan. Medical Jour nal of Malaysia 2006 Mar;61(1):28-35.
21-Zargar AH, SirajM, Jawa AA, Hasan M, Mahtab H. Maintenance of glycaemic control with the evening administration of a long acting sulphonylurea in male type 2 diabetic patients undertaking the Ramadan fast. Int J clin pract 2010; 64(8):1090-4.
22-Loke SC, Rahim KF, KanesvaranR, wong TW. A prospective cohort study on the effect of various risk factors on hypogly caemia in diabetics who fast during Ramadan. Med J Malaysia 2010; 65(1): 3-6.
23-Bravis V, Hui E, salih S, Mehar S, Hassanein M, Devendra D. Ramadan education and awareness in diabetes programme for Muslims with type 2 diabetes who fast during Ramadan. Diabetes Medicine 2010; 27: 327-31.