Ethiopian Orthodox Christian Fasting and Glycemic Outcomes in Type 2 Diabetes: A Facility-based Comparative Cohort Study
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Date
2025
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Addis Ababa Universtity
Abstract
Background: Religious fasting is a common practice across many faith traditions, yet most research on fasting and diabetes has focused on Ramadan fast. Ethiopian Orthodox Christian (EOTC) fasting involves prolonged abstinence from animal products and day time food restriction, but its metabolic implications for patients with diabetes is not well studied
Objective: To assess the impact of Ethiopian Orthodox Christian (EOTC) fasting on glycemic control, anthropometric and lipid parameters, and hypoglycemia risk among patients with type 2 diabetes.
Method: A prospective comparative cohort study was conducted at Tikur Anbessa Specialized Hospital (TASH) among adults with type 2 diabetes who either fasted or did not fast during the Great Lent fast of 2025. Baseline and post-fasting data were collected via a structured questionnaire. Anthropometric measurements and laboratory tests were taken at each time points. Paired and independent t-tests were done to detect within and between group differences, respectively. Regression model was used to identify predictors of hypoglycemia in the fasting group. ANCOVA was used to adjust for baseline imbalances.
Results: A total of 128 participants were included in the study (64 each in each group). There was a significant HbA1c reduction in the fasting group (mean change in HbA1C of -0.4%, 95% CI: -0.7, -0.1) as well as in the non-fasting group (mean change in HbA1C of -0.6%, 95% CI: -0.8, -0.3). However, there was no difference between the two groups with estimated marginal mean (EMM) change 0.1%, 95% CI -0.2,0.5). Similar findings were noted in weight, BMI and waist circumference. A trend towards better lipid benefit was noted in the fasting group but did not attain statistical significance. Hypoglycemia rates were comparable between the two groups (26.6% in the fasting group and 23.4% in the non-fasting group). However, more frequent hypoglycemia (5 or more episodes per person) occurred in 7 (41.2%) patients in the fasting group as compared to 3 (20.0%) in the non-fasting group. There were 3 episodes of level 3 hypoglycemia and all were in the fasting group. Presence of diabetic kidney disease was as an independent predictor of hypoglycemia in the fasting period (aOR=10.9, 95% CI 1.4 to 86.3).
Conclusion: EOTC fasting may be safely practiced by many individuals with type 2 diabetes but individualized risk assessment, structured education, and treatment adjustment are essential
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Keywords
Fasting, Religious, Religious fasting, Diabetes, T2DM, Orthodox, Christian, EOTC, Ethiopia