Flash glucose monitoring system may benefit children and adolescents with type 1 diabetes during fasting at Ramadan

Abstract

Objectives:To assess the benefit of using the flash glucose monitoring system (FGMS) in children and adolescents with type 1 diabetes mellitus (T1DM) during Ramadan fasting.Methods:A prospective pilot study of 51 participants visited the pediatric diabetes clinic at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia from between June until and July 2016. The FreeStyle® Libre™ FGMS (Abbott Diabetes Care, Alameda, CA, USA) was used. Hypoglycemia was defined as glucose values of less than 70 mg/dL, while hyperglycemia as glucose values of more than 150 mg/dL for all participants based on our institute’s protocol.Results:Participants were able to fast for 67.0% of the total days eligible for fasting, whereas they did not fast on 33% of the days due to either hypoglycemia (15.4%) or non-diabetes-related reasons (17.6 %). None of the participants developed severe hypoglycemia. The mean number of hyperglycemic episodes during fasting hours was 1.29, per day, which was higher than that of hypoglycemic episodes (0.7). None of the participants developed diabetic ketoacidosis (DKA). Glycemic control with mean of estimated hemoglobin A1C reading during Ramadan (8.16 ± 1.64% [pre study]) to 8.2 ± 1.63% [post study] p=0.932.Conclusions:Children and adolescents with T1DM who use the FGMS could fast without the risk of life-threatening episodes of severe hypoglycemia (namely seizure, coma), or DKA during Ramadan. Adequate education and good glycemic control prior to Ramadan are important strategies in combination with the use of an FGMS to achieve better outcome.

Safety of Ramadan fasting in young patients with type 1 diabetes: A systematic review and meta‐analysis

“…All studies evaluated the occurrence of hypoglycemia among patients who fasted during Ramadan. There were 10 studies that defined hypoglycemia using a cut‐off of either <4.4, <4.0, <3.9, <3.5, <3.3, <3.0 or <2.9 mmol/L. Another three studies defined hypoglycemia as either a need for breaking the fast or the presence of symptoms of hypoglycemia, irrespective of the glucose level.…”

“…Most studies defined hyperglycemia as a glucose level of >16.7 mmol/L. Two studies used cut‐offs of >8.3 mmol/L for fasting and >13.3 mmol/L for random blood glucose. Another two studies defined hyperglycemia using a random blood glucose level of either >15 mmol/L or >13.9 mmol/L.…”

“…A total of 1,699 patients with type 1 diabetes mellitus were included, with the sample size ranging between five and 1,070. Nine studies involved patients who were treated with the non-CSII regimen 2,8,[10][11][12][13][14][15][16] , three studies involved patients treated with CSII [17][18][19] and five studies compared patients treated with either a non-CSII or CSII regimen [20][21][22][23][24] .…”

“…All studies evaluated the occurrence of hypoglycemia among patients who fasted during Ramadan. There were 10 studies that defined hypoglycemia using a cut-off of either <4.4 24 , <4.0 13 , <3.9 14,18,19,21,23 , <3.5, <3.3 20 , <3.0 16 or <2.9 mmol/L 8 .…”

“…There were four studies that did not specify any cut-off value 2,10,12,15 . In addition, 12 studies documented the proportion of patients who developed hyperglycemia with or without ketosis during Ramadan fasting 2,[10][11][12][13][14][15]17,18,21,23,24 .…”