Mustafa TİMURKAN, Esra SUAY TİMURKAYA, Yılmaz ASLAN, Mehmet KALAYCI, Hakan AYYILDIZ

Does Ramadan fasting affect glicemic control in patients with diabetes mellitus? effects of fasting on betatrophin and insulin resistance

Insulin resistance, which is involved in the pathogenesis of Type 2 Diabetes (T2DM), is considered to be associated with betatrophin. Moreover, it is known that betatrophin levels may be affected by environmental factors. In this study, the changes in pre-Ramadan and post-Ramadan betatrophin levels, HOMA-IR levels, and metabolic parameters were evaluated in patients with T2DM, using oral antidiabetic (OAD) and wanting to fast during Ramadan. 50 patients with T2DM receiving OAD treatment and 40 healthy volunteers were included in the study. Glucose, cholesterol, HDL, LDL, triglyceride measurements were performed with AU-5800 autoanalyzer. Insulin levels were measured with DXI-800 and HbA1c levels with the Premier HB920 device. Furthermore, betatrophin levels were measured using the enzyme-linked immunosorbent assay method. At the beginning and the end of Ramadan, betatrophin levels were detected to be higher in the diabetic group compared to the control group. It was revealed that the post-Ramadan insulin and HOMA-IR levels were lower than the pre-Ramadan values in both of the groups. A positive correlation was found between betatrophin levels and triglyceride (r: 0.289, p= 0.042), and insulin (r: 0.276, p= 0.053) levels in the diabetic group. The study indicated that Ramadan fasting reduced the body mass index and average glucose. Thus, insulin resistance decreased. Betatrophin levels, which may be affected by environmental factors, displayed no changes. Ramadan fasting of diabetic patients in the low and moderate risk group did not disrupt metabolic order and glucose regulation.

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1. International Diabetes Federation. IDF diabetes atlas, ninth edition 2019. https://www.idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html. access date 20.09.2021.

2. The Holy Qur’an Sura 2:v.183-185.

3. Ghouri N, Gatrad R, Sattar N, et al. Summer-winter switching of the Ramadan fasts in people with diabetes living in temperate regions. Diabet Med. 2012;29:696-7.

4. Aadil N, Houti IE, Moussamih S. Drug intake during Ramadan. Br Med J. 2004;329:778-82.

5. Diabetes and Ramadan. IDF-DAR Practical Guidelines 2021. Accessed September 20, 2021. https://www.idf.org/our-activities/education/diabetesand- ramadan.html. access date 20.09.2021

6. Zhang R. Lipasin, a novel nutritionally-regulated liver-enriched factor that regulates serum triglyceride levels. Biochem Biophys Res Commun. 2012;424:786-92.

7. Rong Guo X, Li Wang X, Chen Y, et al. ANGPTL8/betatrophin alleviates insulin resistance via the Akt-GSK3β or Akt-FoxO1 pathway in HepG2 cells. Experimental Cell Research. 2016;345:158-67.

8. Fenzl A, Itariu BK, Kosi L, et al. Circulating betatrophin correlates with atherogenic lipid profilesbut not with glucose and insulin levels in insulinresistant individuals. Diabetologia. 2014;57:1204-8.

9. Wang S, Hong X, Tu Z, et al. Angiopoietin-like protein 8: An attractive biomarker for the evaluation of subjects with insulin resistance and related disorders. Diabetes Res Clin Pract. 2017;133:168-77.

10. Ibrahim M, Davies MJ, Ahmad E, et al. Recommendations for management of diabetes during Ramadan: update 2020, applying the principles of the ADA/EASD consensus. BMJ Open Diabetes Res Care. 2020;8:e001248.

11. BaHammam AS, Almeneessier AS. Recent Evidence on the impact of ramadan diurnal intermittent fasting, mealtime, and circadian rhythm on cardiometabolic risk: a review. Front Nutr. 2020;7.

12. Faris MeA-I, Jahrami H, BaHammam A, et al. A systematic review, metaanalysis, and meta-regression of the impact of diurnal intermittent fasting during Ramadan on glucometabolic markers in healthy subjects. Diabetes Res Clin Pract. 2020;165:108226.

13. Ramlo-Halsted BA, Edelman SV. The natural history of type 2 diabetes. Implications for clinical practice. Prim Care. 1999;26:771-89.

14. Taylor R. Pathogenesis of type 2 diabetes: tracing the reverse route from cure to cause. Diabetologia. 2008; 51:1781-89.

15. Steven S, Hollingsworth KG, Al-Mrabeh A, et al. Very low-calorie diet and 6 months of weight stability in type 2 diabetes: pathophysiological changes in responders and nonresponders. Diabetes Care. 2016;39:808-15.

16. Anton SD, Moehl K, Donahoo WT, et al. Flipping the metabolic switch: Understanding and applying the health benefits of fasting. Obesity (Silver Spring). 2018;26:254-68.

17. Colman RJ, Anderson RM, Johnson SC, et al. Caloric restriction delays disease onset and mortality in rhesus monkeys. Science. 2009;325:201-4.

18. Salti I, Benard E, Detournay B, et al. A Population-based study of diabetes and its characteristics during the fasting month of ramadan in 13 countries: results of the epidemiology of diabetes and ramadan 1422/2001 (EPIDIAR) study. Diabetes Care. 2004;27:2306-11

19. Jabbar A, Hassanein M, Beshyah SA, et al. CREED study: Hypoglycaemia during Ramadan in individuals with Type 2 diabetes mellitus from three continents. Diabetes Res Clin Pract. 2017;132:19-26.

20. Trepanowski JF, Bloomer RJ. The impact of religious fasting on human health. Nutr J. 2010;9:57.

21. Grajower MM, Horne BD. Clinical management of intermittent fasting in patients with diabetes mellitus. Nutrients. 2019;11:873.

22. Shubrook J, Katuna J. A physician’s introduction to therapeutic fasting. Intermittent fasting and type 2 diabetes | diabetes.medicinematters.com access date 20.09.2021

23. Sahin SB, Ayaz T, Ozyurt N, et al. The impact of fasting during Ramadan on the glycemic control of patients with type 2 diabetes mellitus. Exp Clin Endocr Diab. 2013;121:531-4.

24. Bener A, al-Hamaq AOAA, Öztürk M, et al. Effect of Ramadan fasting on glycemic control and other essential variables in diabetic patients. Ann Afr Med. 2018;17:196-202.

25. Chaudhury A, Duvoor C, Reddy Dendi VS, et al. Clinical review of antidiabetic drugs: implications for type 2 diabetes mellitus management. Front Endocrinol. 2017;8:6.

26. Longo VD, Mattson MP. Fasting: Molecular mechanisms and clinical applications. Cell Metab. 2014;19:181-92.

27. de Groot S, Pijl H, van der Hoeven JJM, et al. Effects of short-term fasting on cancer treatment. J Exp Clin Cancer Res. 2019;38:209.

28. Zhang R, Abou-Samra AB. A dual role of lipasin (betatrophin) in lipid metabolism and glucose homeostasis consensus and controversy. Cardiovasc Diabetol. 2014;13:133.

29. Crujeiras AB, Zulet MA, Abete I, et al. Interplay of atherogenic factors, protein intake and betatrophin levels in obese-metabolic syndrome patients treated with hypocaloric diets. Int J Obes (Lond). 2016;40:403-10.

30. Ebert T, Kralisch S, Hoffmann A, et al. Circulating angiopoietin-like protein 8 is independently associated with fasting plasma glucose and type 2 diabetes mellitus. J Clin Endocrinol Metab. 2014;99:E2510-7.