Diabetes mellitus is a chronic illness managed frequently by the family physician. Along with glycaemic control, consideration for other risk factor reduction for micro- and macrovascular complications of diabetes is important. With the introduction of newer pharmacological agents targeting the different pathophysiological aspects of diabetes, it is important for the family physician to make an informed decision, considering the risks and benefits, when choosing the most suitable therapeutic agent. A patient-centered approach is thus crucial in the management of diabetes. This review article focuses on the latest guidelines and new developments in diabetes management in the recent 1-2 years.

INTRODUCTIONMillions of Muslim patients with diabetes mellitus (DM) fast during Ramadan. However, little is known about the metabolic impact of Ramadan fasting. We aimed to study the changes in body composition and metabolic profile in this group of patients.

MATERIALS AND METHODSWe studied 29 Southeast Asian Muslim patients with type 2 diabetes; all underwent pre-Ramadan education. Study variables were weight change, body composition (using multifrequency bioimpedance method, InBody S20®, Biospace, South Korea), blood pressure (BP), glycated haemoglobin (HbA1c), fasting lipid profile, and caloric intake assessment using FoodWorks® nutrient analysis software.

RESULTSTwenty-three subjects fasted ≥15 days; mean ± SD: 57 ± 11 years; 52% were males. HbA1c improved significantly (8.6 ± 2.4% pre-Ramadan vs 8.0 ± 2.3% end-Ramadan, P = 0.017). Despite similar body weight, there was reduction in body fat mass (BFM) (30.9 ± 11 kg vs 29.2 ± 12.2 kg, P = 0.013). Multivariate analysis suggested that the reduction in HbA1c was attributed by reduction in BFM (β = -0.196, P = 0.034). There was no change in visceral adiposity (visceral fat area (VFA)) but stratification by gender showed a reduction amongst females (137.6 ± 24.5 cm2 to 132.5 ± 25.7 cm2, P = 0.017). These changes occurred despite similar total caloric intake (1473.9 ± 565.4 kcal vs 1473.1 ± 460.4 kcal, P = 0.995), and proportion of carbohydrate (55.4 ± 6.3% vs 53.3 ± 7.5%, P = 0.25) and protein intake (17.6 ± 4.1% vs 17.3 ± 5.4%, P = 0.792), before and during Ramadan respectively, but with increased proportion of fat intake (11.9 ± 2.4% vs 13 ± 11.7%, P = 0.04). Seven out of 23 patients had medications adjusted to avert symptomatic hypoglycaemia but none of the patients developed severe hypoglycaemia.

CONCLUSIONRamadan fasting can be practiced safely with prior patient education and medication adjustment. It also confers modest benefits on metabolic profile and body composition, especially among females.

Adult ; Aged ; Biomarkers ; blood ; Blood Glucose ; metabolism ; Body Composition ; Body Mass Index ; Diabetes Mellitus, Type 2 ; blood ; physiopathology ; Energy Intake ; Fasting ; physiology ; Female ; Glycated Hemoglobin A ; metabolism ; Holidays ; Humans ; Islam ; Male ; Middle Aged ; Multivariate Analysis ; Prospective Studies ; Sex Factors ; Singapore ; Weight Gain ; Weight Loss