Mitigation of hypoglycemia during Ramadan using the flash glucose monitoring system following dose adjustment of insulin and sulphonylurea in patients taking multiple glucose-lowering therapies (The PROFAST-IT Study)

Elhadd, Tarik; Bashir, Mohammed; Baager, Khaled A; Ali, Hamda; Al-Mohannadi, Dabia; Dabbous, Zainab; Malik, Rayaz A.; Abou-Samra, Abdul-Badie

doi:10.1016/j.diabres.2020.108589

Cited by 15 publications

(14 citation statements)

References 28 publications

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“…Our predictive model also shows that the risk of hypoglycaemia is related to the time of day which is consistent with previous studies using flash glucose monitoring [6], [9], [30]. Our model also predicts that females are more prone to hypoglycaemia, consistent with our recent study assessing biophysical and biochemical changes during Ramadan [31].…”

Section: Discussionsupporting

confidence: 91%

“…The importance of dose adjustment was confirmed in a subsequent study in patients at high risk of hypoglycaemia, who underwent adjustment of their insulin and/ or SU agent before Ramadan [29],. We have also reported a reduction in hypoglycaemia in a high-risk group assessed using flash glucose monitoring to adjust SU and insulin dose before Ramadan [30],. Interestingly the group on SGLT-2i had more hypoglycaemic episodes before Ramadan, which is consistent with our modelling suggesting that when these agents are part of a complex regimen to lower glucose they may be associated with an increased risk of hypoglycaemia [29].…”

Section: Discussionmentioning

confidence: 73%

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Artificial Intelligence (AI) based machine learning models predict glucose variability and hypoglycaemia risk in patients with type 2 diabetes on a multiple drug regimen who fast during ramadan (The PROFAST – IT Ramadan study)

Elhadd

Mall

Bashir

et al. 2020

Diabetes Research and Clinical Practice

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gender, BMI and HbA1c followed by glucose levels and physical activity. Interestingly, the blood glucose level prediction by our model was influenced by use of SGLT2i. Conclusion:XGBoost, a machine learning AI algorithm achieves high predictive performance for normal and hyperglycaemic excursions, but has limited predictive value for hypoglycaemia in patients on multiple therapies who fast during Ramadan.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 73%

Artificial Intelligence (AI) based machine learning models predict glucose variability and hypoglycaemia risk in patients with type 2 diabetes on a multiple drug regimen who fast during ramadan (The PROFAST – IT Ramadan study)

Elhadd

Mall

Bashir

et al. 2020

Diabetes Research and Clinical Practice

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“…Two RCTs and four observational cohort studies analyzed how insulin dosage adjustment affects glycemic control. Three of the studies reduced the total insulin daily dose by 25% in the experimental groups, and the result was no difference in hyperglycemia compared to regular dosing ( 24 ), no episodes of DKA or NKHS (no comparator) ( 28 ), and no difference in A1c or average blood glucose compared to regular dosing ( 29 ). Shehadeh et al reduced TDD by 40% in their intervention group, giving 60% of the reduced dose as biphasic insulin 70 for iftar and 40% as Levemir at suhur, and their result showed no difference in A1c compared to usual care.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Insulin Management Recommendations to Improve Glycemic Control and Reduce Hypoglycemic Events During Ramadan Fasting in Patients With Insulin-Requiring Type 2 Diabetes

et al. 2022

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BackgroundMuslims with insulin-requiring type 2 diabetes are at high risk of hypo- and hyperglycemia while fasting during the month of Ramadan. Although a few reviews on diabetic management during Ramadan have been published, surveys reveal knowledge gaps remain among physicians.AimThis systematic review qualitatively analyzes what insulin dosing recommendations are likely to reduce hypoglycemic events and improve glycemic control during the Ramadan fasting for this high-risk group.MethodsA comprehensive search in six databases and gray sources was performed from August 10, 2001, to August 10, 2021, for studies assessing which types of insulin and/or what dosing recommendations reduce hypoglycemic events and improve glycemic control during Ramadan. We excluded studies focusing mainly on oral antihyperglycemic medications, type 1 diabetes, persons with insulin pumps, and studies older than 20 years. Hypoglycemic event rates, pre-, and post-iftar blood glucose levels, overall average blood glucose, and hemoglobin A1c were analyzed, and a narrative synthesis was performed.ResultsOut of 1,101 collected articles, 14 eligible studies including 2,969 participants with an average age of 54.8 years, we found that insulin dose reduction may prevent hypoglycemia without causing subsequent hyperglycemia, and rapid-acting insulin analogs may improve post-iftar and overall blood glucose without incurring hypoglycemia.ConclusionsThough initial findings are promising, more research is needed to confirm the benefits of insulin dose reduction, rapid-acting insulin analogs, and ultra-long-acting insulins.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42021268943.

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“…Although reducing insulin resistance is beneficial in people with diabetes, it also bears the risk of hypoglycaemia in people treated with insulin. Data from Ramadan studies are available, showing mitigation of hypoglycaemia during Ramadan using the flash glucose monitoring system 38 . However, data from randomized controlled trials are largely missing.…”

Section: Discussionmentioning

confidence: 99%

INTERmittent FASTing in people with insulin‐treated type 2 diabetes mellitus – the INTERFAST‐2 study protocol

et al. 2022

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Aim: Intermittent fasting, a dietary intervention of alternate eating and fasting, has gained popularity in people trying to lose weight. Intermittent fasting could provide an alternative to classic caloric restriction in people with type 2 diabetes mellitus. The aim of the study is to determine the impact of a 12-week intermittent fasting regimen compared with usual care in people with type 2 diabetes mellitus receiving insulin therapy. Methods:This open, single-centre, randomized controlled trial investigates participants with type 2 diabetes mellitus on insulin therapy and a glycated haemoglobin A1c (HbA1c) of ≥53 mmol/mol (≥7.0%) and a minimum insulin dose of 0.3 IU/kg body weight per day. Participants are randomized in a 1:1 ratio to either 12 weeks of intermittent fasting or the standard care group. All participants receive dietary counselling, continuous glucose monitoring, measurement of the resting metabolic rate, an oral glucose tolerance test, body composition measurement via dual-energy X-ray absorptiometry and stool samples for microbiome analyses at the beginning and at the end of the intervention. Two co-primary outcomes (analysed in hierarchical order) were chosen for the study: (i) the difference in the change of HbA1c from baseline to 12 weeks and (ii) the difference in the number of participants achieving a combined end point encompassing a body weight reduction of at least 2%, an insulin dose reduction of at least 10% and an absolute HbA1c reduction of at least 3 mmol/mol (0.3%) between the two groups.

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Mitigation of hypoglycemia during Ramadan using the flash glucose monitoring system following dose adjustment of insulin and sulphonylurea in patients taking multiple glucose-lowering therapies (The PROFAST-IT Study)

Cited by 15 publications

References 28 publications

Artificial Intelligence (AI) based machine learning models predict glucose variability and hypoglycaemia risk in patients with type 2 diabetes on a multiple drug regimen who fast during ramadan (The PROFAST – IT Ramadan study)

Artificial Intelligence (AI) based machine learning models predict glucose variability and hypoglycaemia risk in patients with type 2 diabetes on a multiple drug regimen who fast during ramadan (The PROFAST – IT Ramadan study)

A Systematic Review of Insulin Management Recommendations to Improve Glycemic Control and Reduce Hypoglycemic Events During Ramadan Fasting in Patients With Insulin-Requiring Type 2 Diabetes

INTERmittent FASTing in people with insulin‐treated type 2 diabetes mellitus – the INTERFAST‐2 study protocol

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