Using FAST tool during Ramadan improves T2D glycaemic control

Using the Fasting Algorithm for Singaporeans with Type 2 Diabetes (FAST) management tool improved glycaemic control among individuals with type 2 diabetes (T2D) who fasted during Ramadan, a recent study showed.

“The FAST tool is a collaborative clinical decision tool that incorporates shared decision making between health care clinicians and fasting individuals and promotes self-efficacy for an effective and safe fasting experience during Ramadan,” explained the researchers.

“[The findings] showed that use of the FAST tool allowed for greater improvement in glycaemic control during Ramadan,” they highlighted.

This trial was conducted over two Ramadan cycles (2017–2018) in Singapore and involved 97 Muslim adults with T2D with baseline HbA_1c ≤9.5 percent (mean 7.8 percent) who fasted for ≥10 days during Ramadan (median 30 days). The participants (mean age 59.5 years, 59.8 percent female, median diabetes duration 10 years) were randomized to receive the FAST intervention (n=46) or usual care (n=51). Those in the intervention arm were trained to use the tool to adjust their medication doses in accordance with their self-monitored blood glucose (SMBG) levels during Ramadan.

During Ramadan, patients in the FAST arm experienced a fourfold improvement in HbA_1c levels compared with those receiving usual care (mean -0.4 percent vs -0.1 percent; p=0.049), with no significant improvement in glycaemic control demonstrated among patients in the latter group. [Ann Fam Med 2020;18:139-147]

Patients in the FAST arm also experienced a decrease in fasting blood glucose (FBG) levels compared with those who received usual care whose levels increased (mean -3.6 vs +20.9 mg/dL, between-group difference 24.5 mg/dL; p=0.034).

The use of FAST enabled maintenance of ADA*-recommended FBG levels, while the FBG levels in those receiving usual care increased to beyond glycaemic targets, noted the researchers.

Changes in postprandial glucose (PPG) levels did not significantly differ between groups (p=0.355), though mean PPG levels decreased to ADA recommended targets in the intervention group.

No self-reported major hypoglycaemia events were reported in either group during Ramadan. Incidence of minor hypoglycaemic events was numerically, but not significantly, lower in the intervention vs control arms, be it by SMBG <72 mg/dL (8.7 percent vs 11.8 percent; p=0.744) or actual event (2.2 percent vs 9.8 percent; p=0.154).

Glycaemic variability – frequency of fluctuations in blood glucose levels – also did not significantly differ between the intervention and usual care arms during Ramadan (27.2 percent vs 25.2 percent; p=0.284), nor did incidence of diabetes distress** (p=0.479).

The between-group difference in HbA_1c levels between the post-Ramadan assessment and 3-month follow-up was no longer significant once the intervention recipients reverted to usual care (p=0.077).

“The FAST protocol opens the door to a safe approach to fasting for Islamic patients who observe Ramadan, and its application can extend … beyond fasting for spiritual reasons,” noted Dr Jonathan Gabison from the University of Michigan, Ann Arbor, Michigan, US, in an editorial. [Ann Fam Med 2020;18:98-99] This includes patients with T2D who are attempting weight loss, though this requires more research, he said.