The Impact of Ramadan Fasting On The Glycemic Control of Type 2 Diabetes Mellitus Patients : a Systematic Review
Bibliographic record
Abstract
Background: Majority of Muslim with type 2 diabetes mellitus (T2DM) fasted during Ramadan regardless of possible health risk complication. Despite reports on the beneficial impact of intermittent fasting on the glycemic control of T2DM, the impact of Ramadan fasting has been inconsistent. This systematic review aims to assess the impact of Ramadan fasting on the glycemic control of T2DM patients.Methods: Literature searching was done at March 2019 at PUBMED, EBSCOhost and Proquest database using combination of the following keywords: Ramadan fasting, type 2 diabetes mellitus, glycemic profile, fasting glucose and HbA1c. Observational studies conducted in adult human, published in English within 10 years which analyze the glucose parameter (fasting plasma glucose or FPG and HbA1c) among T2DM patients during Ramadan fasting were included in the data analysis. All studies were assessed for its risk of bias using New-Castle Ottawa Scale. The heterogeneity of the studies was analyzed using I2 (square) test and the overall mean difference between FPG and HbA1c before and after Ramadan fasting was calculated using Weighted Mean Difference (WMD) test using Stata 13.Results: A total of 13 observational studies with moderate to high quality that were conducted in Middle Eastern and Asian countries were included in the data analysis. The included studies recruited T2DM patients aged 49 to 60 year olds who fasted for 10 days to full Ramadan month. All of the included studies were considered heterogeneous with I2 >75%. Two studies reported an increase in FBG level while four studies reported the contrary. Whereas two studies reported a significant increase in HbA1c level, seven studies reported the contrary, and one study reported neutral effect. In the WMD pooled analysis, the mean FBG level decreased by -0.72 mmol/L (95%CI -0.88-(-0.56), p<0.001 while the mean HBA1c level decreased significantly by -0.13% (95%CI -0.20-(-0.07), p <0.001. Conclusion: Ramadan fasting, despite associated with variable effects on glycemic control, was associated with an overall decrease of both FBG and HbA1c. The fact that most clinicians prioritize hypoglycemia prevention during the Ramadan month might contribute to these findings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.031 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.007 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".