(P23-020-25) Weight Loss With Different Types of Fasting in Patients With Type Two Diabetes and Hypertension: A Randomized Clinical Trial

Objectives: To compare different Ramadan fasting (RF) (antique and modern) on glycemic, blood pressure (BP), lipids, bone mineral density (BMD), and ejection fraction (EF) in patients with type two diabetes (T2D), hypertension (H), and heart failure (HF).

Methods: A 60-day, controlled, randomized clinical trial including 51 patients (29 women) with T2D+H+HF: 26 in Main (antique RF); 25 in Controls (modern/conventional RF). In Main 14 patients and in Controls 13 patients had HF with I-II stages of the NYHA functional classification. Primary endpoints: weight loss, fasting glucose and, insulin, HOMA-IR, BP, EF. Secondary endpoints: lipids, BMD. Main adhered to fasting on ancient RF with two principles of nutrition: 1) “don’t eat meat and don’t eat fatty foods” in the allotted time; 2) the ‘Sehri time’ (a meal eaten before dawn) included just 1.5-2.0 glass of water and fruits of 80-100 gr. After 30-day ancient RF, Main was followed by 30-day time-restricted feeding (TRF) 20:4. Controls were on modern RF with: 1) no restrictions to eat meat and/or fat meal to the ‘Sehri time’ and ‘Iftar time’ (a meal eaten after sunset). After 30-day modern RF Controls switched to a regular diet. Both groups at baseline received conventional symptomatic drugs.

Results: Main lost weight –8.02 kg (P < 0.0001), Controls lost weight –2.67 kg (P < 0.025); BMI in Main significantly decreased (P < 0.0001), in Controls did not (P >0.025). During 30-day follow-up, Main did not regain weight and WC; Controls regained both. In Main BP, all glycemic parameters, lipids (cholesterol, triglyceride, HDL), BMD, and EF in patients with and without heart failure (HF)> were normalized at 30-day RF (P < 0.0001). In Controls BP and all glycemic parameters significantly improved but they did not achieve normal (P>0.025). In Controls BMD and EF in patients with HF did not change (P>0.025). At 30-day follow-up, glycemic, BP, lipids, BMD, and EF parameters did not significantly change in Main; but in Controls they worsened as weight regained.

Conclusions: Both the RF methods allowed weight loss, but antique RF led to markedly weight loss and positive change in glycemic, BP, lipids, BMD, and EF in patients with T2D+H+HF; antique RF allowed patients to stop taking medications.

Funding Sources: Ministry of Science and Higher Education of the Republic of Kazakhstan (Grant for 2024-2026 years, AP23488544). ClinicalTrials.gov NCT06410352