Effect of Ramadan fasting on diabetes mellitus: A population-based study in Qatar

Abstract

Background:
Over one billion Muslims fast worldwide during the month of Ramadan. Fasting during Ramadan is a radical change in lifestyle for the period of a lunar month, and it might affect the biochemical parameters among diabetic patients.

Aim:
This study aimed to investigate the effect of Ramadan fasting on the blood levels of glucose, glycated hemoglobin (HbA1c), and lipid profile among diabetic patients observing fast during the Ramadan.

Patients and methods:
An observational study recruiting 1301 Muslim diabetic patients above 18 years age was conducted in diabetic outpatient clinic of Hamad General Hospital, Hamad Medical Corporation, and Primary Health Care Center, Qatar, from July 2012 to September 2013. Data on sociodemographic characteristics (age, sex, nationality, marital status, education level, and occupation) and lifestyle habits (smoking and physical activity), blood pressures, and anthropometric measurements were obtained by a face-to-face interview and measurement using a structured questionnaire. Blood samples were collected for testing glucose, glycosylated hemoglobin (HbA1C), lipid profile, urea, and creatinine (by the licensed research assistants).

Results:
Slightly less than half of the participants were overweight (BMI: 25-29.9). Significantly higher proportion of female participants were obese as compared with male participants (P<0.001). Among both male participants and female participants, the average level of blood glucose, HbA1c, total cholesterol, low-density and high-density lipoprotein cholesterol, triglycerides, albumin, bilirubin, uric acid, and systolic and diastolic blood pressures were significantly lower during the Ramadan as compared with before Ramadan (P<0.001 each).

Conclusion:
Results revealed that fasting during Ramadan is significantly associated with decrease in blood lipid profile, blood pressures, glucose, and HbA1C level among diabetic patients. Muslim diabetic patients after the consultation of their primary physician can fast during the month of Ramadan and it might be beneficial for their health.

Full text

Effect of Ramadan fasting on diabetes mellitus: a population-
based study in Qatar
Abdulbari Bener
a,b,c
and Mohammad T. Yousafzai
d
a
Department of Medical Statistics and Epidemiology,
Hamad Medical Corporation, Doha,
b
Department
of Public Health, Weill Cornell Medical College,
Ar-Rayyan, Qatar,
c
Department of Public Health and
Primary Care, Faculty of Medical and Human Science,
The University of Manchester, Manchester, UK and
d
Department of Pediatrics and Child Health, Aga Khan
University, Karachi, Pakistan
Correspondence to Abdulbari Bener, Department of
Medical Statistics and Epidemiology, Hamad Medical
Corporation, PO Box 3050, Doha, Qatar
Tel: + 974 4439 3765; + 974 4439 3766;
fax: + 974 439 3769;
e-mails: abener@hmc.org.qa;
abb2007@qatar-med.cornell.edu
Received 6 March 2014
Accepted 14 June 2014
Journal of the Egyptian Public Health
Association 2014, 00:000–000
Background
Over one billion Muslims fast worldwide during the month of Ramadan. Fasting during
Ramadan is a radical change in lifestyle for the period of a lunar month, and it might
affect the biochemical parameters among diabetic patients.
Aim
This study aimed to investigate the effect of Ramadan fasting on the blood levels of
glucose, glycated hemoglobin (HbA1c), and lipid profile among diabetic patients
observing fast during the Ramadan.
Patients and methods
An observational study recruiting 1301 Muslim diabetic patients above 18 years age
was conducted in diabetic outpatient clinic of Hamad General Hospital, Hamad
Medical Corporation, and Primary Health Care Center, Qatar, from July 2012 to
September 2013. Data on sociodemographic characteristics (age, sex, nationality,
marital status, education level, and occupation) and lifestyle habits (smoking and
physical activity), blood pressures, and anthropometric measurements were obtained
by a face-to-face interview and measurement using a structured questionnaire. Blood
samples were collected for testing glucose, glycosylated hemoglobin (HbA1C), lipid
profile, urea, and creatinine (by the licensed research).
Results
Slightly less than half of the participants were overweight (BMI: 25–29.9). Significantly
higher proportion of female participants were obese as compared with male
participants (Po0.001). Among both male participants and female participants, the
average level of blood glucose, HbA1c, total cholesterol, low-density and high-density
lipoprotein cholesterol, triglycerides, albumin, bilirubin, uric acid, and systolic and
diastolic blood pressures were significantly lower during the Ramadan as compared
with before Ramadan (Po0.001 each).
Conclusion
Results revealed that fasting during Ramadan is significantly associated with decrease
in blood lipid profile, blood pressures, glucose, and HbA1C level among diabetic
patients. Muslim diabetic patients after the consultation of their primary physician can
fast during the month of Ramadan and it might be beneficial for their health.
Keywords:
blood glucose, diabetes mellitus, epidemiology, HbA1C, Ramadan fasting
J Egypt Public Health Assoc 00:000–000
&2014 Egyptian Public Health Association
0013-2446
Introduction
One of the five fundamental rituals of Islam, the religion
professed by over one billion people, is fasting during the
month of Ramadan. Muslims neither eat nor drink
anything from dawn until sunset [1,2]. The time of
observance differs each year because it is a lunar calendar.
Fasting period varies with the geographical site and the
season. In summer months and northern latitudes, the
fast can last up to 18 h or more. Muslims observing the
fast must not only abstain from eating and drinking, but
also from taking oral medications, smoking as well as
intravenous fluids and nutrients [1–7].
The prevalence of diabetes mellitus (DM) in several
countries with large Muslim populations appears to be similar
to the rates observed in western countries and is increasing by
10% per year as a result of urbanization and socioeconomic
development [2]. Indeed, fasting is one of the five pillars of
Islam. However, when fasting may significantly affect the
health of the faster or when an individual is sick, Islam
exempts that person from fasting. However, a significant
number of patients persists in fasting against the advice of
their doctors and the permission of religious authorities [2].
DM [1,5] and cardiovascular diseases [3,8–10] are
approaching epidemic proportions worldwide and is
associated with substantial public and personal bur-
den [2]. DM is one of the major causes of mortality and
morbidity in most developed and developing countries
[7–9]. Fasting during Ramadan is essentially a radical
Original article 1
0013-2446 &2014 Egyptian Public Health Association DOI: 10.1097 /01.EPX.0000451852.92252.9b
CE: Diana ED: Maitreyee Op: Mandar EPX: LWW_EPX_892-4

change in lifestyle for the period of 1 lunar month that
may affect diabetic and cardiac patients [2–4,10,11].
During the Ramadan fast, Muslims eat two meals, one
before dawn and the other shortly after sunset. This change
of meal schedule is accompanied with changes in sleep habit
(shortening of time to sleep) and lifestyle habits [11–14].
The drug schedule during the day time is changed because
of fasting, which may have an effect on DM patients. Fasting
is not obligatory for children or menstruating women; sick
and traveling people are excused from fasting [1,2].
In Arabian Gulf countries during the month of Ramadan,
Muslim people usually go for very high calorie food; they
neither diet nor exercise, and they sleep and work for less
hours [4,11–14]. Despite the large number of Muslims
worldwide, there is lack of data on DM in Ramadan. The
objective of this study was to investigate the effect of
Ramadan fasting on the blood levels of glucose, glycated
hemoglobin (HbA1c), and lipid profile among diabetic
patients observing fast during Ramadan in Qatar.
Patients and methods
Study patients and setting
This is an observational study that was conducted among
Arab Muslim diabetic patients above 18 years of age,
registered in diabetic clinics of Hamad General Hospital,
Hamad Medical Corporation (HMC), and Primary Health
Care centers in Qatar during the period from July 2012 to
September 2013. Of the total 1645 eligible participants,
1301 (79.15%) agreed and gave their consent to take part
in this study. IRB ethical approval was obtained from
HMC before commencing data collection.
Data collection methods
Questionnaire
Qualified nurses who can speak and write both English and
Arabic were recruited to administer the questionnaires and
perform anthropometric measurements. A standardized
questionnaire-based face-to-face interview was conducted
by the nurses to fill the questionnaires. The questionnaire
was composed of: (a) sociodemographic data such as age,
sex, nationality, marital status, education level, occupation,
height, weight, and parental consanguinity; (b) Anthropo-
metric data such as height and weight; (c) lifestyle habits
such as physical activity and smoking status; (d) Blood
pressure measurements; and (e) Laboratory investigations
during and before Ramadan, such as blood glucose, glycated
hemoglobin (HbA1c), low-density and high-density lipo-
protein (HDL and LDL) cholesterol, cholesterol levels,
triglyceride, urea, creatinine, bilirubin, albumin, etc. Data
related to anthropometry and laboratory were filled based
on actual measurements and laboratory investigations as
described below during Ramadan. Laboratory investigations
before the Ramadan were obtained from the respective
medical records.
Anthropometric measurements
Height was measured in centimeters using a height scale
(SECA
AQ1 , Germany) while the patient was standing bare
feet and with normal straight posture. Weight was
measured in kilograms using a weight scale (SECA).
BMI was calculated as the ratio of weight (kg) to the
square of height (m). A person was considered obese if
the BMI value was at least 30 kg/m
2
and overweight if
BMI was greater than 25 kg/m
2
and less than 30 kg/
m
2
[11,15,16].
Blood pressure measurements
Hypertension was defined according to the WHO, which
is systolic blood pressure at least 130 mmHg or diastolic
blood pressure at least 85 mm Hg or using antihyperten-
sive medication. Two readings of systolic blood pressure
and diastolic blood pressure were taken from the
participant’s left arm while seated and his/her arm at
heart level, using a standard zero mercury sphygmoman-
ometer after at least 10–15 min of rest. Thereafter, the
average of the two readings was obtained [16–18].
Lifestyle habits
Smoking habit was classified in terms of currently being
past or current smoker or nonsmoker. Patients were
classified as physically active, if they reported participat-
ing in walking or cycling for more than 30 min/day.
Laboratory measurements
A blood sample of 10 ml was collected through venipunc-
ture from each participant after fasting for 10 h into
vacutainer tubes containing EDTA. The samples were
kept at room temperature and transported within 2 h to a
central certified laboratory at Hamad General Hospital,
HMC Doha Qatar. Plasma glucose, total cholesterol,
triglyceride, HDL-cholesterol, and LDL-cholesterol were
measured by an autoanalyzer (Hitachi AQ2
747 autoanalyzer,
Japan). Glycosylated hemoglobin (HbA1c) was analyzed
using a high-performance liquid chromatography method.
Other biochemical values such as creatinine, potassium,
bilirubin, and uric acid were collected from their latest
medical records [16].
Definitions
Diabetes mellitus
The presence of DM was determined by the documenta-
tion in the patient’s previous or current medical record of
a documented diagnosis of DM that had been treated
with medications or insulin [19–21].
Ramadan
Time periods corresponding to the month of Ramadan in
the Gregorian calendar have been established, as the
lunar calendar is 11–12 days shorter than the solar
year [1,2]. More than 95% of Qatari and other Arabs
Muslim adults fast without fail during the month of
Ramadan. Data were collected at the beginning of the
month.
Statistical analysis
Data were entered and analyzed using SPSS version 21
(IBM Corp., Armonk, New York, USA). Student’s paired
t-test was used to determine difference between baseline
and 1 month before, regarding biochemistry parameters,
2Journal of the Egyptian Public Health Association

and this was confirmed by the Wilcoxon signed ranked
test, which is a nonparametric test that compares two
paired groups. The w
2
and the Fisher exact tests were
performed to test for differences in proportions of
categorical variables between two or more groups. The
level of Pless than 0.05 was considered as the cutoff
value for significance.
Results
Table 1 shows comparison of sociodemographic and
lifestyle characteristics of the participants in Qatar
(N= 1301). Of 1301 participants, 675(51.9%) were
men. The mean ± SD age of the participants was
45.9 ± 15.3 years. Female participants were significantly
older than male participants (46.8 ± 16.1 vs. 44.7 ± 14.5;
P= 0.031, respectively). Overall, about two-third of the
participants were Qatari nationals, with significantly
higher proportion among female participants as compared
with male participants (females: 79.6% Qatari and 20.4%
non-Qatari, whereas males: 49.6% Qatari and 50.4% non-
Qatari; Po0.001). In addition, about three quarters of
the participants were married with significant difference
across sex (Po0.001). Slightly less than half of the
participants were overweight (BMI: 25–29.9 kg/m
2
),
whereas the proportion of normal weight and obese
participants was equal. Significantly higher proportion of
female participants were obese as compared with male
participants (Po0.001) (Table 1).
Table 2 shows the comparison of mean biochemical
characteristics and blood pressures among the partici-
pants before and during Ramadan. On average, blood
glucose, HbA1c level, total cholesterol, triglycerides,
HDL-C, LDL-C, bilirubin, albumin, uric acid, and
systolic and diastolic blood pressures were significantly
lower during the holy month of Ramadan as compared
with before Ramadan (Po0.001 for each).
Table 3 shows the comparison of biochemical character-
istics and blood pressures among male and female
participants before and during the holy month of
Ramadan fasting. Among both male and female partici-
pants, the mean ± SD blood glucose levels were sig-
nificantly different before and during the fasting of holy
month of Ramadan (8.44 ± 2.09 vs. 7.62 ± 2.10; Po0.001
and 9.08 ± 2.33 vs. 8.27 ± 2.19; Po0.001, respectively).
In addition, mean ± SD HbA1c levels were significantly
lower among both male and female participants during
Ramadan as compared with before Ramadan (8.15 ± 2.02
vs. 8.66 ± 2.04; Po0.001 and 8.37 ± 2.04 vs. 8.88 ± 2.11;
Po0.001, respectively). Both LDL and HDL cholesterol
levels were significantly reduced among both men and
women during Ramadan fasting as compared with before
Ramadan (Po0.001). In addition, total cholesterol and
triglycerides were also significantly reduced among both
men and women during Ramadan fasting (men:
4.87 ± 1.02 vs. 5.64 ± 0.79; Po0.001 and 1.42 ± 0.63 vs.
1.67 ± 0.81; Po0.001, women: 4.94 ± 1.12 vs. 5.67 ±
0.83; Po0.001 and 1.39 ± 0.61 vs. 1.63 ± 0.80; Po0.001,
respectively).
Figure 1 shows comparison of average HbA1c level before
and during the holy month of Ramadan fasting across
different age groups. There was a significant decrease in
HbA1c level during Ramadan as compared with before
Ramadan in each age group among both men and women.
Discussion
The present study included representative Muslim
diabetic population in the State of Qatar where more
than 95% of the Muslims fast regularly during the holy
month of Ramadan. The current study found positive
impact of Ramadan fasting on blood glucose level,
HbA1C, and lipid profile. It revealed significant reduc-
tion in blood sugar (Po0.001). This was confirmed by
HbA1C that showed significant improvement
(Po0.001), which is consistent with the previous
reports [1,4–7,13,14]. Moreover, the study did not find
any negative effects of Ramadan fasting during the holy
month of Ramadan on the status of DM concerning lipid
profile – LDL, HDL, cholesterol, and triglyceride. This is
consistent with that reported in other stu-
dies [1,4–7,14,19–24].
In fact, although blood sugar levels in diabetes can be
achieved through manipulation of diet, exercise, and
medication [1,14], a change in any one of these three
things can skew blood sugar levels and create complica-
tions associated with hyperglycemia or hypoglycemia.
Fasting during the month of Ramadan is a religious
activity that devout Muslims practice whether they are
diabetic or not. As such fasting involves abstinence from
food and water for 12 h or more during the day from dawn
to dusk, it is evident that advice regarding exercise and
medication will have to be modified appropriately during
this period [1–4]. There is ample evidence that it is safe
for well-controlled diabetics to fast during the month of
Ramadan [1,2,19,20].
Sahin et al. [6] examined 122 patients in Istanbul with type 2
diabetes before and after Ramadan; 88 of 122 patients fasted
during Ramadan. The frequencies of both severe hypergly-
cemia and hypoglycemia were higher in the fasting group,
but the difference was not significant. Weight, BMI, waist
circumference, blood pressure, fasting blood glucose
(143.38 ± 52.04 vs. 139.31 ± 43.47 mg/dl), postprandial
glucose (213.40 ± 98.56 vs. 215.66 + 109.31 mg/dl), fructo-
samine (314.18 ± 75.40 vs. 314.49 ± 68.36 mmol/l), HbA1c
(6.33 ± 0.98 vs. 6.22 ± 0.92%), and fasting insulin
(12.61 ± 8.94 vs. 10.51 ± 6.26 mU/ml) were unchanged in
patients who fasted during Ramadan. Microalbuminuria
significantly decreased during Ramadan (132.85 ± 197.11 vs.
45.03 ± 73.11 mg/dl). They concluded that fasting during
Ramadan did not worsen the glycemic control of patients
with type 2 diabetes.
More recent studies did not find any negative effects of
extended fasting on glucose regulation of patients with
diabetes who are using certain medications. No serious
adverse event was observed, and they have failed to
demonstrate benefits of increasing the number of meals
Ramadan fasting and diabetes mellitus Bener and Yousafzai 3

in patients with diabetes [5,13,14]. This is confirmative
with the current reported study.
Meanwhile, Ramadan fasting for pregnant women with
diabetes remains controversial and underreported. A
retrospective study carried out by Ismail et al. [13] in a
tertiary hospital in Malaysia over a period of 3 years
including pregnant diabetic women, who were on short-
acting, intermediate-acting, or a combination of them,
and opted to carry out Ramadan fasting, investigated the
glycemic control in pregnant diabetic women on insulin
who fasted during Ramadan. Glycemic control was
assessed before, in the middle of, and after Ramadan
fasting. There was no difference between glycemic
Table 1. Comparison of sociodemographic and lifestyle characteristics of the participants in Qatar (N= 1301)
n(%)
Total Male (n= 675) Female (n= 626) Pvalue
Age (mean ± SD) (years) 45.9 ± 15.3 44.9 ± 14.5 46.8 ± 16.1 0.031
Age (years)
o30 247 (19) 117 (17.3) 130 (20.8) o0.001
30–39 169 (13) 110 (16.3) 59 (9.4)
40–49 266 (20.4) 148 (21.9) 118 (18.8)
50–59 408 (31.4) 232 (34.4) 176 (28.1)
Z60 (mean ± SD) 211 (16.2) 68 (10.1) 143 (22.8)
Nationality
Qatari 833 (64) 335 (49.6) 498 (79.6) o0.001
Non-Qatari 468 (36) 340 (50.4) 128 (20.4)
Marital status
Single 220 (16.9) 120 (17.8) 100 (16) o0.001
Married 980 (75.3) 523 (77.5) 457 (73)
Divorced 38 (2.9) 16 (2.4) 22 (3.5)
Widow 63 (4.8) 16 (2.4) 47 (7.5)
BMI (kg/m
2
)
o25 354 (27.2) 213 (31.6) 141 (22.5) o0.001
25–29.9 590 (45.3) 304 (45) 286 (45.7)
Z30 357 (27.4) 158 (23.4) 199 (31.8)
Level of education
Illiterate 229 (17.6) 120 (17.8) 109 (17.4) 0.206
Elementary 278 (21.4) 154 (22.8) 124 (19.8)
Intermediate 271 (20.8) 146 (21.6) 125 (20)
Secondary 340 (26.1) 158 (23.4) 182 (29.1)
University 183 (14.1) 97 (14.4) 86 (13.7)
Household income (QR)
o5000 97 (7.5) 51 (7.6) 46 (7.3) 0.641
5000–10 000 417 (32.1) 208 (30.8) 209 (33.4)
10 000–15 000 464 (35.7) 251 (37.2) 213 (34)
Z15 000 323 (24.8) 165 (24.4) 158 (25.2)
Consanguinity
Yes 509 (39.1) 273 (40.4) 236 (37.7) 0.311
No 792 (60.9) 402 (59.6) 390 (62.3)
Smoking status
Never 1097 (84.3) 523 (77.5) 574 (91.7) o0.001
Current smoker 142 (10.9) 111 (16.4) 31 (5)
Past smoker 62 (4.8) 41 (6.1) 21 (3.4)
Physical activity
Yes 388 (29.8) 208 (30.8) 180 (28.8) 0.417
No 913 (70.2) 467 (69.2) 446 (71.2)
Table 2. The comparison of biochemical characteristics and blood pressures among participants before and during Ramadan in both
sexes (N= 1301)
Blood investigations During Ramadan (mean ± SD) Before Ramadan (mean ± SD) Change (paired t-value) (95% CI) Pvalue
Blood glucose 7.93 ± 2.17 8.75 ± 2.24 – 0.81 (– 0.85 to – 0.77) o0.001
HbA1C 8.25 ± 2.02 8.77 ± 2.07 – 0.51 (– 0.56 to – 0.47) o0.001
Urea 4.22 ± 1.62 4.26 ± 1.69 – 0.04 (– 0.11 to 0.02) 0.219
Creatinine 63.54 ± 16.70 64.14 ± 14.96 – 0.60 (–1.26 to 0.07) 0.077
Bilirubin 6.22 ± 2.24 6.79 ± 2.11 – 0.57 (– 0.61 to – 0.53) o0.001
Albumin 40.76 ± 4.19 41.60 ± 4.04 – 0.85 (– 1.02 to – 0.67) o0.001
Cholesterol 4.90 ± 1.07 5.65 ± 0.80 – 0.75 (– 0.82 to – 0.69) o0.001
Triglycerides 1.41 ± 0.62 1.65 ± 0.81 – 0.24 (– 0.27 to – 0.22) o0.001
HDL-C 1.34 ± 0.35 1.42 ± 0.29 – 0.07 (– 0.09 to – 0.06) o0.001
LDL-C 2.63 ± 0.76 2.78 ± 0.99 – 0.15 (– 0.20 to – 0.09) o0.001
Uric acid 284.36 ± 95.42 296.17 ± 95.31 – 11.81 (– 13.50 to – 10.12) o0.001
Blood pressure
Systolic 125.77 ± 14.17 130.63 ± 14.29 –4.86 (– 4.93 to – 4.79) o0.001
Diastolic 77.57 ± 8.92 81.42 ± 9.25 – 3.84 (– 3.91 to – 3.76) o0.001
Two-sided Pvalues based on paired t-test.
HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol.
4Journal of the Egyptian Public Health Association

control of type 2 DM and gestational DM women before
fasting. In the middle of Ramadan, serum fructosamine
decreased in both groups. However, only serum HbA1c
was reduced in gestational DM after Ramadan. They
concluded that the pregnant diabetic women on insulin
were able to fast during Ramadan and that their glycemic
control was improved during fasting period.
Carbohydrate and lipid metabolism is influenced by
fasting, resulting in changes in blood chemistry. There is
no caloric intake during fasting, and the continual use of
glucose in the body for various vital functions [23] leads
to lowering of blood glucose level. The depletion of
glycogen stores after prolonged fasting further decreases
its level. Our study participants demonstrated lower
levels of blood glucose during the month of Ramadan,
which were consistent with the observations reported by
earlier workers [6,13,23–25]. The variation in lipid levels
observed by different workers may be attributed to the
difference in dietary habits and duration of fasting in
different seasons and countries. It is also obvious from the
present study that the benefits of Ramadan dietary habits
in terms of reduction in cholesterol, TGs, and LDL levels
and rise in HDL levels are transient and may be helpful
only if the diet pattern is framed according to the routine
followed in Ramadan on regular basis [23].
Ensuring good control of plasma glucose during the
fasting month of Ramadan is a challenge for both
Table 3. The comparison of biochemical characteristics and blood pressures among participants before and during Ramadan
according to sex (N= 1301)
Blood investigations During Ramadan (mean ± SD) Before Ramadan (mean ± SD) Change (paired t-value) (95% CI) Pvalue
Blood glucose
Male 7.62 ± 2.10 8.44 ± 2.09 – 0.82 (– 0.88 to – 0.76) o0.001
Female 8.27 ± 2.19 9.08 ± 2.33 – 0.80 (– 0.87 to – 0.74) o0.001
HbA1C
Male 8.15 ± 2.02 8.66 ± 2.04 – 0.51 (– 0.57 to – 0.46) o0.001
Female 8.37 ± 2.04 8.88 ± 2.11 – 0.51 (– 0.59 to – 0.44) o0.001
Urea
Male 4.25 ± 1.65 4.23 ± 1.72 0.02 (– 0.07 to 0.11) 0.679
Female 4.18 ± 1.60 4.29 ± 1.67 – 0.11 (– 0.20 to – 0.02) 0.022
Creatinine
Male 66.46 ± 18.12 66.95 ± 15.43 – 0.50 (– 1.56 to 0.57) 0.362
Female 60.40 ± 14.41 61.11 ± 13.83 – 0.71 (– 1.48 to 0.06) 0.070
Bilirubin
Male 6.38 ± 2.29 6.98 ± 2.16 – 0.60 (– 0.66 to – 0.55) o0.001
Female 6.05 ± 2.17 6.58 ± 2.04 – 0.53 (– 0.59 to – 0.47) o0.001
Albumin
Male 40.96 ± 4.41 41.86 ±4.13 – 0.89 (– 1.13 to – 0.65) o0.001
Female 40.53 ± 3.93 41.32 ± 3.93 – 0.79 (– 1.04 to – 0.55) o0.001
Cholesterol
Male 4.87 ± 1.02 5.64 ± 0.79 – 0.77 (– 0.85 to – 0.68) o0.001
Female 4.94 ± 1.12 5.67 ± 0.83 – 0.73 (– 0.83 to – 0.64) o0.001
Triglycerides
Male 1.42 ± 0.63 1.67 ± 0.81 – 0.25 (– 0.28 to – 0.22) o0.001
Female 1.39 ± 0.61 1.63 ± 0.80 – 0.23 (– 0.27 to – 0.20) o0.001
HDL-C
Male 1.32 ± 0.32 1.40 ± 0.27 – 0.07 (– 0.10 to – 0.05) o0.001
Female 1.37 ± 0.37 1.44 ± 0.32 – 0.07 (– 0.10 to – 0.05) o0.001
LDL-C
Male 2.63 ± 0.79 2.78 ± 1.14 – 0.15 (– 0.24 to – 0.06) 0.001
Female 2.62 ± 0.72 2.77 ± 0.80 – 0.15 (– 0.21 to – 0.08) o0.001
Uric acid
Male 289.13 ± 95.09 300.43 ± 96.85 – 11.29 (– 13.63 to – 8.96) o0.001
Female 279.15 ± 95.59 291.52 ± 93.45 – 12.37 (–14.83 to – 9.91) o0.001
Blood pressure
Systolic
Male 125.34 ± 13.42 130.14 ± 13.55 – 4.80 (– 4.91 to – 4.69) o0.001
Female 126.23 ± 14.95 131.16 ± 15.03 – 4.93 (– 5.01 to – 4.84) o0.001
Diastolic
Male 76.89 ± 8.77 80.65 ± 9.23 – 3.76 (– 3.89 to – 3.64) o0.001
Female 78.33 ± 9.04 82.24 ± 9.20 – 3.92 (– 3.98 to – 3.85) o0.001
Two-sided Pvalues based on paired t-test.
HDL-C, high-density lipoprotein cholesterol.
Figure 1.
7.0
7.5
8.0
8.5
9.0
9.5
<30 30-39 40-49 50-59 =>60
Age groups (Years)
Mean HbA1c(%)
Female
7.0
7.5
8.0
8.5
9.0
9.5 Before Ramadan
During Ramadan
Male
Comparison of mean HbA1c across different age groups before and
during the holy month of Ramadan fasting.
Ramadan fasting and diabetes mellitus Bener and Yousafzai 5

physicians and patients [1]. Along with these changes in
medication, it is important that doctors educate their
patients about how their plasma glucose depends on the
relationship between food intake and glucose-lowering
medication. Patients should also be told of the need to
monitor their plasma glucose on a regular basis through-
out the fasting month [14].
Conclusion
This study revealed that fasting during Ramadan is
significantly associated with decrease in blood lipid
profile, blood pressures, glucose, and HbA1C level among
diabetic men and women. Muslim diabetic patients after
the consultation of their physicians can fast during the
month of Ramadan, and it might be beneficial
AQ3 for their
health.
Acknowledgements
This work was generously supported and funded by the Qatar
Foundation Grant No. UREP 13-136-3-025. The authors thank the
Hamad Medical Corporation for their support and ethical approval
(HMC RP # Research proposal #13234/13).
Conflicts of interest
None declared
AQ4 .
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6Journal of the Egyptian Public Health Association

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