Effects of Ramadan Fasting on Diabetic Nephropathy in Type 2 Diabetic Patients

Abstract Background Type 2 diabetes is a chronic metabolic disease that has a significant impact on the health, quality of life, and life expectancy of patients, as well as on the health care system. Diabetic nephropathy is one of the major complications of diabetes, characterized by proteinuria and renal insufficiency. The development of microalbuminuria is an early marker for diabetic nephropathy, which is potentially modifiable through lifestyle changes and pharmacological interventions targeting blood glucose and blood pressure, specifically through the renin angiotensin system. Aim of the Work The aim of this work is to study the effect of Ramadan fasting on diabetic nephropathy in type 2 diabetic patients. Patients and Methods Our study conducted on 90 type 2 diabetic patients, their age between 40-60 years; all of them are welling to fast the whole month of Ramadan, selected from the outpatient clinic of endocrinology, Ain Shams University Hospitals. Results There was a highly statistically significant increase in Creatinine (p < 0.001) as well as a highly statistically significant increase in urea after Ramdan in all studied group (P < 0.001). The Percentage change in GFR was significantly higher in macroalbuminuria. The Percentage change in A/C ratio in micro and macroalbuminuria were significantly lower when compared to normoalbuminuria, as well as in macroalbuminuria when compared to microalbuminuria groups. (P = 0.001). There were no significant differences found regarding, body mass index;, systolic blood pressure, diastolic blood pressure fasting blood glucose, postprandial blood glucose, HbA1c before and after Ramadan. Conclusion Ramadan fasting has no harmful impact on albuminuria among patients with T2DM. However, fasting leads to a significant decline in renal function parameters among diabetic patients with albuminuria. This decline is more prominent in patients with macroalbuminuria than patients with microalbuminuria. Thus, fasting should be avoided in patients with a severe decline in renal functions. Patients should be advised regarding adequate hydration and dietary modification during Pre-Ramadan health care education. On the other hand, Ramadan fasting has no negative impacts on glycemic control and other metabolic parameters. Nevertheless, further trials that assess the role of fasting in at-risk patients are still needed.