Impact of Ramadan on Physical Activity and Sleeping Patterns in Individuals with Type 2 Diabetes: The First Study Using Fitbit Device

Diabetes Ther https://doi.org/10.1007/s13300-020-00825-x ORIGINAL RESEARCH Impact of Ramadan on Physical Activity and Sleeping Patterns in Individuals with Type 2 Diabetes: The First Study Using Fitbit Device Abdullah S. Alghamdi . Khalid A. Alghamdi . Richard O. Jenkins . Mohammed N. Alghamdi . Parvez I. Haris Received: March 26, 2020 Ó The Author(s) 2020 ABSTRACT Introduction: The impact of Ramadan fasting, a type of intermittent fasting, on the management of diabetes has not been well investigated. Physical activity, sleep duration, and time of sleep are susceptible to alterations during Ramadan due to the changes in the times and numbers of meals. This study compared physical activity and sleep patterns of individuals with type 2 diabetes mellitus (T2DM) during and after Ramadan using the international physical activity questionnaire (IPAQ) and a Fitbit Flex 2 accelerometer. Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/m9.figshare. 12155568. Electronic Supplementary Material The online version of this article (https://doi.org/10.1007/s13300020-00825-x) contains supplementary material, which is available to authorized users. A. S. Alghamdi (&)
R. O. Jenkins
P. I. Haris Faculty of Health and Life Sciences, De Montfort University, Leicester, UK e-mail: ; A. S. Alghamdi General Directorate of Medical Services of the Interior Ministry, Riyadh, Saudi Arabia K. A. Alghamdi
M. N. Alghamdi Al Iman General Hospital, Riyadh, Saudi Arabia Methods: Saudi individuals (n = 36) with T2DM completed a self-reported questionnaire and wore a Fitbit device for seven consecutive days during and after Ramadan. Fitbit generated weekly step counts, activity intensities, sedentary time, and sleep durations and times. IPAQ was used to estimate the physical activity and sitting time of participants in each period. Sleep patterns were assessed in each period by a selfreported questionnaire. Results: Both Fitbit and IPAQ indicated a high prevalence of low physical activity among the participants with non-significant variances between the during and after Ramadan periods. Also, a significant short daily total sleeping hours and daily night-time sleeping hours was seen during the Ramadan period. The duration of night-time sleep was observed to be low in each period. Conclusions: This is the first study to use a Fitbit device to monitor individuals with T2DM who chose to fast during Ramadan. The study shows a high prevalence of low physical activity among Saudi individuals with T2DM in each period, and short sleep durations in the during Ramadan period compared to after Ramadan period. A high prevalence of short night-time sleep duration and excessive daytime sleeping was observed in both periods and significantly in the during Ramadan period. A larger study is needed in the future covering before, during, and after Ramadan to evaluate the impact of lifestyle changes related to Ramadan fasting on type 2 diabetes. Diabetes Ther Keywords: Diabetes; Fitbit; IPAQ; activity; Ramadan; Sleep; T2DM Physical Key Summary Points Why carry out this study? Saudi Arabia has one of the highest prevalences of diabetes in the world with over 30% of its population affected by type 2 diabetes. This has negative impacts on the lives of individuals and is a great burden on the healthcare system and the economy of the country. Physical activity and sleeping patterns are important factors for managing diabetes. These are susceptible to alterations during the month of Ramadan when most adult Saudis perform a type of intermittent fasting, from dawn till dusk for 29–30 days. How Ramadan fasting alters sleeping and physical activity of Saudis with type 2 diabetes has not been well investigated. What was learned from the study? High prevalence of physical inactivity among study participants is a cause for concern and further research is needed in this area with a larger population. Short sleeping duration during Ramadan and prevalence of short night-time sleep after Ramadan may have adverse effects on the health of individuals with type 2 diabetes which needs to be further investigated. INTRODUCTION Diabetes mellitus is a common chronic disease, which has been estimated to affect 31.6% of the Saudi population [1]. Different factors, such as environmental, social, and lifestyle factors, have been linked with the treatment and incidence of type 2 diabetes mellitus (T2DM). For instance, several studies have demonstrated that increased physical activity and enhanced sleep quality are essential factors for better outcomes in the control of T2DM [2–6]. Increased physical activity has been reported to be correlated with reduced HbA1c and glycaemic levels, and decreased cardiovascular complications among individuals with T2DM [7–9]. The benefits of physical activity on T2DM have been shown through the significant improvements in the sensitivity of insulin [10]. However, physical inactivity can increase the susceptibility of developing of T2DM or worsen the diabetic condition in individuals who are already suffering from this condition [3, 6, 11]. Unfortunately, physical inactivity has been reported to be common among the Saudi population, where the General Authority for Statistics in Saudi Arabia recently reported that only 17.4% of Saudis are performing physical activity for 150 min or more per week [12]. For the sleep quality, both long and short sleep durations have been previously reported to be associated with increased HbA1c levels [13, 14]. Sleep during the night-time is important for the metabolic process, which has been shown to facilitate blood glucose regulation that is essential for diabetes outcomes [15]. Short duration of sleeping during the nighttime has been observed among a portion of the Saudi population [16, 17]. In addition, numerous studies have shown that the disturbance of the circadian rhythm can cause T2DM or make it worsen through affecting glucose homeostasis, insulin secretion, and insulin sensitivity [18–20]. The month of Ramadan is the ninth month in the lunar year, in which healthy adult Muslims abstain from any type of food, drink, or medicine administered through the mouth, smoking, and sexual interaction from dawn to dusk each day for 29 or 30 days [21]. As a result of some activities during the month of Ramadan and changes in the numbers and times of meals, Ramadan has been reported to be associated with alterations in sleeping durations and times, and physical activities [22–27]. These changes may affect public health, and Diabetes Ther particularly individuals with diabetes. At worst, these may minimise the achievement of optimal positive impact of intermittent fasting during Ramadan, which has been previously reported to be beneficial for T2DM [28–31]. Therefore, the investigation of the physical activity and sleeping patterns of Muslim individuals with T2DM during Ramadan, using a precise measurement tool, is needed (...truncated)