Impact of Ramadan focused education program on hypoglycemic risk and metabolic control for patients with type 2 diabetess

Background: Fasting during the month of Ramadan could lead to acute complications and increased hypoglycemic risk of patients with type 2 diabetes. Therefore, diabetes is one of the diseases that need careful observation and special considerations during Ramadan including patients’ education and counseling. Objectives: To evaluate the impact of Ramadan focused education program on acute complications and biomedical parameters. Methods: A prospective nonrandomized interventional controlled design was run on three phases: before, during, and after Ramadan on 262 type 2 diabetes patients. The intervention group (n=140) received focused individualized diabetic education sessions and antidiabetic medications adjustment before and after Ramadan, while the control group (n=122) received standard diabetic care. A validated hypoglycemia questionnaire was used in both groups to assess the change of the risk. Patients were advised to adjust the dosage and timing of antidiabetic agents according to the recommendations for management of diabetes during Ramadan. Primary outcomes were postintervention change of hypoglycemia score and HbA1c over 6-month follow-up. Data were presented as mean ± standard deviation. HbA1c was expressed in percentage. Results: The hypoglycemic scores before, during, and after Ramadan were 14.21±8.50, 6.36±6.17, and 5.44±5.55 in the intervention group, respectively (P,0.001) and 14.01±5.10, 13.46±5.30, and 9.27±4.65 in the control group, respectively (P,0.001). HbA1c levels were 9.79±1.89, 8.26±1.54, and 8.52±1.61 before, during, and after Ramadan in the intervention group, respectively (P,0.001), and 10.04±1.47, 9.54±1.38, and 9.59±1.79 in the control group, respectively (P,0.001). Post-Ramadan reductions of HbA1c and hypoglycemic scores were significantly higher in the intervention group (-13.0% vs -4.5%, P=0.004 for HbA1c and -61.7% vs -33.8%, P,0.001 for hypoglycemic score). Low-density lipoprotein cholesterol improved in the intervention group from 2.41±0.91 mmol/L before Ramadan to 2.28±0.68 mmol/L after Ramadan (P,0.001). No statistically significant effects were observed on blood pressure or body weight in the intervention group. Also, no change was observed in the control group. Conclusion: Ramadan educational program had a positive impact with reduction of hypoglycemic risk, HbA1c, and low-density lipoprotein cholesterol. Therefore, it could be recommended for patients with increased risk of hypoglycemia during Ramadan fasting

The association of metformin use with vitamin B12 deficiency and peripheral neuropathy in Saudi individuals with type 2 diabetes mellitus.

AIMS:To compare the prevalence of vitamin B12 deficiency and peripheral neuropathy between two groups of type 2 diabetes mellitus (T2DM) patients treated with or without metformin, and to determine factors associated with vitamin B12 deficiency therapy and dietary intake of vitamin B12. METHODS:In this retrospective study, we recruited 412 individuals with T2DM: 319 taking metformin, and 93 non-metformin users. Demographics, dietary assessment for vitamin B12 intakes, and medical history were collected. Participants were assessed for peripheral neuropathy. Blood specimens were collected and checked for serum vitamin B12 levels. The differences between the two groups were analyzed using an independent t-test for continuous data, and the Chi-squared or Fisher's exact test was used for categorical data. The relationship of vitamin B12 deficiency with demographics and clinical characteristics was modeled using logistic regression. RESULTS:The prevalence of B12 deficiency was 7.8% overall, but 9.4% and 2.2% in metformin users and non-metformin users, respectively. The odds ratio for serum vitamin B12 deficiency in metformin users was 4.72 (95% CI, 1.11-20.15, P = 0.036). There were no significant differences in a test of peripheral neuropathy between the metformin users and non-metformin users (P > 0.05). Low levels of vitamin B12 occurred when metformin was taken at a dose of more than 2,000 mg/day (AOR, 21.67; 95% CI, 2.87-163.47) or for more than 4 years (AOR, 6.35; 95% CI, 1.47-24.47). CONCLUSION:Individuals with T2DM treated with metformin, particularly those who use metformin at large dosages (> 2,000 mg/day) and for a longer duration (> 4 years), should be regularly screened for vitamin B12 deficiency and metformin is associated with B12 deficiency, but this is not associated with peripheral neuropathy