Background: Insulin degludec (IDeg) is an ultra-long-acting insulin, with flat time-action profile, having a lower risk of hypoglycemia. Many adolescents with type 1 diabetes, choose to observe Ramadan fasting for spiritual wellbeing despite different risks.
Aim of study: To assess frequency, timing and severity of hypoglycemia of insulin IDeg as basal insulin in T1DM adolescence who are willing to fast. Other outcomes included glycemic control, number of days needed to break fasting, and acute glycemic complications.
Methods: Thirty eight patients (19 males) with T1DM (mean age 15.8 ± 3.4 years) and duration of diabetes (5.2 ± 1.7 years) were included. Patients had their IDeg doses titrated using pre- Iftar (sunset-meal) and pre-Suhur (sunrise-meal) glucose values. Target glucose values were aimed to be a pre-Suhur value of 120 mg/dl, and pre-Iftar value of 130-150 mg/dl. Participants were able to adjust their bolus doses according insulin to carbohydrates ratios for each meal. IDeg was reduced initially by 15% of pre-Ramadan dose and administered at time of Iftar. Patients were monitored using the FreeStyle Libre® flash glucose monitoring (FGM)system. Analysis of hypoglycemia were extracted from downloads and compared between different times according to eating pattern in Ramadan.
Results: At the end of Ramadan, mean BG was 176 ± 49 mg/dl and overall time spent in hypoglycemia was 5.7%±3.0% of total monitoring period. The rate of hypoglycemia according to time intervals was 0%,3%, 8%, 15%and 64% in (19:0024:00), (24:0004:00), (04:00-10:00), (10:0014:00) and (14:0019:00) respectively. Out of all hypoglycemic flashes for patients, 74% were between60 and 69 mg/dl, 23% between 50 and 59 mg/dl, and 5% below 50mg/dl. The mean number of episodes of breaking fast was 3 (1-7). There was no significant change (P = 0.211) in glycemic control measured by fructosamine level between pre-Ramadan ( 221.7 ± 63.8 mg/dL) and end-of-Ramadan ( 234.8 ± 71.7 mg/dL). Insulin bolus dose had increased by 15% of the starting dose (P = 0.03) while basal insulin was reduced by 35±18%. No DKA or hospital admissions were reported.
Conclusion: Once daily dosing of IDeg provides safe and effective alternative for glycemic control with a significant lower risk of hypoglycemia. Hypoglycemia was encountered in the last few hours of fasting preceding Iftar time necessitating dose reduction to minimize the severity and duration of hypoglycemia. This helps adolescents with T1DM observe Ramadan in a healthy and fulfilling manner under close supervision.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology