The effects of camel milk (CM) intake on glycemic control in patients with diabetes are controversial. This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to summarize the effect of CM intake on glucose homeostasis parameters in patients with both types of diabetes mellitus; T1DM and T2DM. We searched Google Scholar, PubMed/MEDLINE, EBSCO host, CINAHL, ScienceDirect, Cochrane, ProQuest Medical, Web of Science, and Scopus databases from inception until the end of November 2021. Relevant RCTs were identified, and the effect size was reported as mean difference (MD) and standard deviation (SD). Parameters of glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), postprandial blood glucose (PBG), fasting serum insulin (FI), insulin resistance (expressed in terms of HOMA-IR), insulin dose (ID) received, serum insulin antibody (IA), and C-peptide (CP) were tested. Out of 4054 collected articles, 14 RCTs (total 663 subjects) were eligible for inclusion. The pooled results obtained using a random-effects model showed a statistically significant decrease in HbA1c levels (MD, −1.24, 95% confidence interval (CI): −2.00, −0.48, p < 0.001 heterogeneity (I²) = 94%) and ID received (MD, −16.72, 95% CI: −22.09, −11.35 p < 0.00001, I² = 90%), with a clear tendency was shown, but non-significant, to decrease FBG (MD, −23.32, 95% CI: −47.33, 0.70, p = 0.06, I² = 98%) in patients with diabetes who consumed CM in comparison to those on usual care. Conversely, the consumption of CM did not show significant reductions in the rest of the glucose homeostasis parameters. Subgroup analysis revealed that patients with T2DM were more beneficially affected by CM intake than those with T1DM in lowering FBG, while patients with T1DM were more beneficially affected by CM intake than those with T2DM in lowering HbA1c. Both fresh and treated (pasteurized/fermented) CM gave similar beneficial effects in lowering HbA1c. Lastly, a relatively superior effect for longer duration on shorter duration (>6 months, ≤6 months, respectively) of CM intake is found in lowering HbA1c. To conclude, long-term consumption of CM by patients with diabetes could be a useful adjuvant therapy alongside classical medications, especially in lowering the required insulin dose and HbA1c. Due to the high heterogeneity observed in the included studies, more controlled trials with a larger sample size are warranted to confirm our results and to control some confounders and interfering factors existing in the analyzed articles.

Context: Ramadan fasting (RF) is associated with various physiological and metabolic changes among fasting Muslims. However, it remains unclear whether these effects are attributable to changes in meal timing or changes in dietary energy and macronutrient intakes. Furthermore, the literature on the associations between RF, meal timing, and energy and macronutrient intakes is inconclusive. Objectives: This systematic review aimed to estimate the effect sizes of RF on energy and macronutrient intakes (carbohydrates, protein, fats, dietary fiber, and water) and determine the effect of different moderators on the examined outcomes. Data Sources: The Cochrane, CINAHL, EMBASE, EBSCOhost, Google Scholar, PubMed/MEDLINE, ProQuest Medical, Scopus, ScienceDirect, and Web of Science databases were searched from inception to January 31, 2022. Data Extraction: The studies that assessed energy, carbohydrate, protein, fat, fiber, and water intakes pre- and post-fasting were extracted. Data Analysis: Of the 4776 identified studies, 85 relevant studies (n = 4594 participants aged 9–85 y) were selected. The effect sizes for the studied variables were as follows: energy (number of studies [K] = 80, n = 3343 participants; mean difference [MD]: −142.45; 95% confidence interval [CI]: −215.19, −69.71), carbohydrates (K = 75, n = 3111; MD: −23.90; 95% CI: −36.42, −11.38), protein (K = 74, n = 3108; MD: −4.21; 95% CI: −7.34, −1.07), fats (K = 73, n = 3058; MD: −2.03; 95% CI: −5.73, 1.67), fiber (K = 16, n = 1198; MD: 0.47; 95% CI: −1.44, 2.39), and water (K = 17, n = 772; MD: −350.80; 95% CI: −618.09, 83.50). Subgroup analyses showed age significantly moderated the 6 dietary outcomes, and physical activity significantly moderated water intake. There were significant reductions in energy, carbohydrate, and protein intakes during RF. Conclusions: The change in meal timing rather than quantitative dietary intake may explain various physiological and health effects associated with RF.

Introduction The prevalence of type 2 diabetes (T2D) is increasing around the world. Although Muslims with a physical illness are exempted from fasting during the month of Ramadan, a great number still choose to fast, often without medical consultations. The aim of this systematic review and meta-analysis was to investigate the impact of observing Ramadan fasting (RF) on glycaemic control in patients with T2D. Methods The Web of Science, Scopus, EBSCOhost, CINAHL, ScienceDirect, Cochrane Library, ProQuest Central and Europe PubMed Central (Medline) databases were searched for relevant studies published between January 2000 and December 2021. Observational studies that examined the changes in body weight (BW) and glucose parameters (glycosylated haemoglobin [HbA1c] and fasting blood glucose [FBG]), before and after RF among different age groups with T2D were included in the systemic review and meta-analysis. Effect sizes for the tested outcomes were calculated as weighted mean difference (WMD), with their confidence intervals (CI). Quality assessment was examined using the National Heart, Lung, and Blood Institute (NHLBI) tool. Results Of the 1592 identified records, 12 studies conducted in Middle Eastern and Asian countries were eligible and included in the quantitative analyses. The quality of the retrieved studies was evaluated and found to range between fair (83%) and good (17%). These 12 studies included 5554 participants of whom 54% were males and 46% were females. Our pooled analysis demonstrated that HbA1c and FBG levels significantly decreased after RF when compared to the pre-fasting levels (WMD = 0.55 mg/dl, 95% CI 0.33–0.77, P < 0.00001, Ι² = 93% and WMD = 12.42, CI 6.46–18.38, P < 0.0001, Ι² = 81%, respectively). However, the difference in BW in fasting patients after RF versus the pre-fasting stage was non-significant. Although, young patients with T2D were enrolled in the 12 selected studies, we did not find any studies that solely focussed on this group. Conclusion The impact of RF on adult patients with T2D is associated with favorable outcomes. However, future studies should evaluate data from young adults separately. In addition, it is essential to identify the effects of the number of fasting days (level of exposure), diet, level of physical activity and sleeping pattern on optimal glycaemic control. This information could be utilized by medical professionals as a non-pharmacological therapeutic method for management of diabetes in patients who are willing to practice fasting during Ramadan and other months of the year. Study Registration PROSPERO: CRD42022314752.