ESPE Abstracts

Background: Ramadan fasting may influence metabolic control in Type 1 Diabetes Mellitus. Fructosamine is an accurate metabolic control in a short-term period. Comparison of fructosamine between intensive and conventional insulin regimen in T1DM children has not been widely studied.

Objective: To compare fructosamine level between intensive and conventional insulin regimens during Ramadan Fasting in T1DM.

Methods: Observational analytic study was conducted in endocrine-outpatient-clinic Dr. Soetomo hospital during Ramadan 2013 and 2015. Inclusion criterias were T1DM in children performed Ramadan fasting before, and already diagnosed >6 months before the study. Exclusion criterias were severe hypoglycemia < 3 months before the study, recurrent hypoglycemia(blood glucose levels<65 mg/dl), hyperglycemia with diabetic ketoacidosis (DKA) < 3 months before study conducted, hospitalized patients, kidney and liver disease and severe malnutrition. Fructosamine was evaluated 3 times (one week before, in the middle and at the end of Ramadan fasting). Daily blood glucose monitoring, DKA events, and hypoglycemia episodes were observed. Patients were divided into 2 groups: group 1 given intensive-treatment (Detemir, short-acting insulin) and group 2 conventional (intermediate, short-acting insulin).

Results: Twenty-four T1DM fasting children were included. Fourteen were girls, mean age 14.92 (range 9–18) years. Nine children in group 1 and 15 children in group 2. Duration of illness was 4.48 (range1–9) years. Mean of fructosamine before Ramadan: 518.5(254–757)μmol/L, middle: 502.8(276–745)μmol/L, and at the end of Ramadan: 495.3(267–743) μmol/L (P>0.05). Comparison of Fructosamine level between groups before (497.1 vs. 531.2 μmol/L, P=0.5), middle (458.2 vs. 529.6 μmol/L, P=0.1) and at the end of Ramadan (467 vs. 512 μmol/L, P=0.4) were not significant (P>0.05). Most subjects (91.6%) had hyperglycemia without DKA with a mean of frequency 17.3 times. Neither symptomatic hypoglycemia nor DKA was found in this study.

Conclusions: Fructosamine level during Ramadan fasting between intensive and conventional insulin regiments were similar. Type-1 DM fasting children did not experience symptomatic hypoglycemia or DKA.

Keywords: fructosamine, metabolic control, T1DM, ramadan fasting, insulin