In patients with T1DM who fast Ramadan, there was no difference in rates of hypoglycemia or hyperglycemia between CSII and MDI. However, CSII was associated with less glucose variability.

ObjectiveFasting Ramadan is associated with changes in lifestyle patterns of patients with diabetes who choose to perform fasting. We aimed to determine the attitude and habits of patients with type 1 diabetes during fasting Ramadan.MethodsThe study comprised a prospective cohort of patients with type 1 diabetes who were on insulin pump or multiple daily insulin injections (MDI) regimen. Patient questionnaires included the frequency of self-monitoring of blood glucose (SMBG), the need to make changes in insulin regimen by patients, timings of insulin administration, performing carbohydrate counting and levels of physical activity.ResultsA total of 156 patients were studied (61 patients on insulin pump and 95 patients on MDI). Patients on pump therapy performed SMBG more frequently than those on MDI regimen (4.8 ± 1.4 and 3.7 ± 1.7 times per day, respectively, P = 0.001) and were more likely to perform carbohydrate counting (32.7% and 8.4% of pump and MDI patients, respectively, P < 0.001). There was no difference in the percentage of patients who made changes in insulin doses (74.5% of the pump group and 77.3% of MDI patients) or those who had any level of physical activity (12.5% of the pump group and 21.1% of the MDI group). The timing of administering meal insulin in relation to sunset meal was variable with a preference to taking the injection immediately at sunset. There was no difference in glucose control between both groups as measured by frucotsamine levels or the number of days that patients have to stop fasting.ConclusionFasting Ramadan is associated with significant and variable changes in the attitude and behaviors of patients with type 1 diabetes with no difference in glucose control between patients on insulin pump or MDI regimen. Further studies are needed to define the role of education and its effect on these attitudes and patient care in this population.ClinicalTrials.gov Identifier: NCT01941238.

IDF-DaR guidelines recommend change of basal insulin timing to early evening. Randomized trials examining timing of basal insulin during fasting are lacking. Objective: To compare glucose profiles in T1DM patients taking Glargine at early evening (6-7 pm) versus bedtime (10-12 night) during fasting Ramadan. Methods: Multicenter open label randomized controlled trial. Patients recruited in 4 centers from 4 cities in Saudi Arabia. Data collected using pre- and post-Ramadan questioners. Glucose data collected via self-monitoring (Roche AccuCheck glucometer/the Abbott Freestyle Libre), and Envision iPro CGM. Results: 185 T1DM patients randomized; 91 to glargine at 6-7pm (early), and 94 at 10-12 night (late). 32.4% ≤18 years, 53% female, and average duration of DM 11 ±11. No significant differences between the two groups in demographics or DM complications. Early vs. late group: Pre Ramadan A1c 9 ±2.7 vs. 8.75 ±2.1, p=0.35, post Ramadan A1c 8.4 ±2.9 vs. 8.7 ±2.7, p=0.5. Breaking of fast reported in 66 (75.9%) vs. 71 (76.3%), p=0.94; average number of days 4±6 vs. 4±4, p=0.5, and due to hypoglycemia in &gt;90% of cases for both groups. Hypoglycemia most common in Morning 32 (59.3%) vs. 38 (60.35%), p=0.85. Severe hypoglycemia reported in 2 vs. 5 patients, and 1 DKA admission in each group. Combined CGM data during Ramadan: A1c 7.6 ±1.7 vs. 7.7 ±2.1, p=0.63. Average Time in range of 70-180 mg/dl 44.6% vs. 46.1%, p=0.7, Time below range (&lt;70mg/dl) 7.9% vs. 6.4%, p=0.35, and Time above range (&gt;180mg/dl) 47.5 vs. 47.5%, p=0.99. Total hypoglycemic episodes detected by SMBG 4 ±6 vs. 3 ±8, p=0.3, and Low excursions detected by iPro CGM 5 ±6 vs. 4 ±5.5, p=0.22, with AUC below limit 0.5 ±1 vs. 0.15 ±0.85, p=0.03. Conclusion: Changing glargine timing during Ramadan to early evening hours carries no significant advantage over keeping at bedtime in regards to hypoglycemia and overall glucose profiles. ClinicalTrials.gov: NCT04383990. Disclosure R. Alamoudi: None. M. Hassanein: None. G. S. Khogeer: None. A. Al qarni: None. Y. M. Saleh: Advisory Panel; Self; American Association of Clinical Endocrinologists, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk, Research Support; Self; Servier Laboratories, Speaker’s Bureau; Self; Abbott Diabetes, Amgen Inc., Ascensia Diabetes Care, Lilly Diabetes, Sanofi-Aventis. A. Aljawhrji: None. M. R. Alsubaiee: None. H. A. Zarif: Advisory Panel; Self; Pfizer Foundation, Speaker’s Bureau; Self; Medtronic. S. B. Alaidarous: Other Relationship; Self; AstraZeneca, Novo Nordisk. S. A. Khashwayn: None. Funding King Abdullah International Research Center