Diabetes Mellitus, Type 2 Clinical Trial
— FASTOfficial title:
Development and Implementation of Ramadan "Fasting Algorithm for Singaporeans With Type 2 Diabetes" (FAST): A Prospective Randomized Controlled Intervention Study
Verified date | February 2020 |
Source | National University, Singapore |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Background: Ramadan fasting is a religious observance carried out by Muslims all over the
world. During Ramadan, Muslims abstain from eating, drinking, and smoking during daylight
hours. Although Muslims who are ill, including patients with diabetes, are exempted from
fasting, many devoted Muslim patients still insist on fasting despite being advised not to by
their healthcare providers. Concerns have been raised over how the practice of fasting may
affect the metabolic control of Muslim patients with diabetes. Furthermore, it has also been
postulated that the act of fasting may increase the risk of hypoglycemia or glucose toxicity.
Although practice algorithms and suggestions on the use of glycemic therapies during fasting
have been discussed internationally. they are not generalizable as the observances of
Ramadan, duration of fasting and the food ingested differ from one country to another.
Aims: This study aims to develop and implement a clinical practice dose-adjustment algorithm
dedicated to the care of Singaporean patients with diabetes who fast during Ramadan.
Hypothesis: The use of clinical practice dose-adjustment algorithm can improve both clinical
and humanistic outcomes of patients with type 2 diabetes who wish to fast during Ramadan.
Methods: This is a prospective, randomized, interventional study involving patients with type
2 diabetes who wish to fast for at least 10 days during Ramadan. Eligible patient attending a
primary care institution or an outpatient specialist clinic of a tertiary institution will be
approached to participate in the study. Consented patients will be randomized to either
intervention arm or control arm. Patients in the control arm will receive usual care while
patients in the intervention arm will be given additional education session on Ramadan
fasting related diabetic management advice and an algorithm that was developed by the study
team members based on international guidelines, to guide them on self-management during
Ramadan. The primary outcomes will be change in HbA1c. Secondary outcomes include change in
fasting blood glucose, post prandial blood glucose, medication adherence and humanistic
outcomes. The safety outcomes include self reported incidence of major and minor hypoglycemia
as well as hyperglycemia during Ramadan month. All outcomes will be measured at baseline,
during Ramadan and at 3 month post Ramadan.
Significance: The validation of the algorithm through this study will ensure effective and
safe fasting of patients with type 2 diabetes during Ramadan.
Status | Completed |
Enrollment | 111 |
Est. completion date | February 6, 2019 |
Est. primary completion date | February 6, 2019 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 21 Years to 90 Years |
Eligibility |
Inclusion Criteria: - All Muslim patients over 21 years of age with Type 2 diabetes who plan to fast for at least 10 days during the month of Ramadan Exclusion Criteria: - Patients with history of recurrent hypoglycemia - Patients who are pregnant - Patients with eGFR<30ml/min 3 months prior to Ramadan - Patients with HbA1c > 9.5% - Patients with DM-related admission 1 month prior to Ramadan - Patients on active short-term corticosteroid treatment - Patients who are unable to complete the questionnaires |
Country | Name | City | State |
---|---|---|---|
Singapore | National Healthcare Group Polyclinic (Bukit Batok) | Singapore | |
Singapore | Tan Tock Seng Hospital | Singapore |
Lead Sponsor | Collaborator |
---|---|
Joyce Lee | National Healthcare Group, Singapore, National University, Singapore, Tan Tock Seng Hospital |
Singapore,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Change in HbA1c | Change in HbA1c during and after Ramadan from baseline | Baseline Pre-Ramadan (3 months prior to Ramadan), during Ramadan (+ 4 weeks) and post Ramadan (3 months after Ramadan) | |
Secondary | Incidence of minor and major hypoglycemia | Incidence of minor hypoglycemia which is defined as signs and symptoms with known precipitating causes such as irregular eating habits, increased daily activity or other attributes that can be modified. Major hypoglycemia is defined as any hypoglycemic symptoms that require the help from another person. | During one month of Ramadan | |
Secondary | Incidence of hyperglycemia | Incidence of hyperglycemia which is defined as signs and symptoms of frequent urination, increased thirst or fruity-smelling breath. | During one month of Ramadan | |
Secondary | Change in fasting blood glucose (FPG) | Change in FPG during and after Ramadan from baseline | Baseline Pre-Ramadan (3 months prior to Ramadan), during Ramadan (+ 4 weeks) and post Ramadan (3 months after Ramadan) | |
Secondary | Change in post-prandial blood glucose | Change in 2 hours post meal during and after Ramadan from baseline | Baseline Pre-Ramadan (3 months prior to Ramadan), during Ramadan (+ 4 weeks) and post Ramadan (3 months after Ramadan) | |
Secondary | Change in blood pressure | Change in BP during and after Ramadan from baseline | Baseline Pre-Ramadan (3 months prior to Ramadan), during Ramadan (+ 4 weeks) and post Ramadan (3 months after Ramadan) | |
Secondary | Change in lipid panel | including LDL, TG, TC, HDL | Baseline Pre-Ramadan (3 months prior to Ramadan) and post Ramadan (3 months after Ramadan) | |
Secondary | Change in general health status | EQ-5D-5L | Baseline Pre-Ramadan (3 months prior to Ramadan) and during Ramadan (+ 4 weeks) | |
Secondary | Change in diabetes-related distress | Problem Area in Diabetes (PAID) | Baseline Pre-Ramadan (3 months prior to Ramadan) and during Ramadan (+ 4 weeks) | |
Secondary | Change in diabetes-specific quality of life | Audit of Diabetes Dependent Quality of Life (ADDQoL) | Baseline Pre-Ramadan (3 months prior to Ramadan) and during Ramadan (+ 4 weeks) | |
Secondary | Change in diabetes treatment satisfaction | Diabetes Treatment Satisfaction Questionnaires (DTSQ) | Baseline Pre-Ramadan (3 months prior to Ramadan) and during Ramadan (+ 4 weeks) |
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