Impact of Ramadan intermittent fasting on metabolic and inflammatory profiles in type 2 diabetic patients

Purpose The aim of this study was to assess the impact of Ramadan intermittent fasting on metabolic and inflammatory profiles in type 2 diabetic patients (T2D). Methods It was a prospective study including 55 T2D patients treated with oral hypoglycemic drugs, who intended to observe Ramadan fasting in 2019. All participants underwent a questionnaire, a physical examination, laboratory investigations, and a cardiovascular risk assessment using the Framingham score before Ramadan (T0), immediately after Ramadan (T1), and two months after Ramadan (T2). Results The mean age of participants was 54.5 +/- 10.1 years. The number of fasted days was 29.3 +/- 2.3 days. The mean total daily calorie intake decreased significantly by 19% during Ramadan (p < 10(-3)). A significant decrease in weight (79.8 +/- 12.9 vs 78.4 +/- 13.3 kg, p = 0.003), body mass index (29.8 +/- 5.4 vs 29.2 +/- 5.4 kg/m(2), p = 0.004), waist circumference (98.2 +/- 9.6 vs 96.3 +/- 10.2 cm, p = 0.015), fat body mass (24.3 +/- 9.4 vs 23.5 +/- 9.7 kg, p = 0.043) was observed at T1. The weight loss was significantly correlated with the number of fasting days (r = 0.348, p = 0.009) and was maintained at T2. Serum fructosamine increased at T1 (303.6 +/- 46 vs 333.49 +/- 59.49 mu mol/L, p < 10(-3)) and returned to its baseline levels at T2. A significant decrease in insulin (9.7 +/- 5.5 vs 7.98 +/- 5.05 mIU/L, p = 0.043), fibrinogen (3.7 +/- 0.8 vs 3.4 +/- 0.6 g/L, p = 0.003), and hs-CRP (4.8 +/- 5.7 vs 3.7 +/- 4.5 mg/L, p = 0.058) levels was observed at T1. Homocysteine level was significantly higher after Ramadan (12.2 +/- 6.2 vs 13.5 +/- 6.4 mu mol/L, p = 0.001). However, no significant changes were found in blood pressure, fasting blood glucose, HOMA-IR, uric acid, lipids, and white blood cells count. The mean Framingham score decreased insignificantly after Ramadan. Conclusions Ramadan fasting in T2D patients seems to have a favorable impact on anthropometric parameters and inflammatory profile. However, it may cause a transient worsening of glycemic control.