ESPE Abstracts

Objectives: The study aimed to observe and compare the short-term glycaemic outcome among Muslim type 1 diabetes mellitus (T1DM) children and adolescents using retrospective continuous glucose monitoring (CGM) before and during Ramadan month. The selection of retrospective CGM over real-time CGM conferred the benefit of representing the actual glycaemic impact of Ramadan fasting, especially relevant to developing Muslim nations that have less access to personal CGM.

Methodology: This observational prospective study was conducted in both Hospital Putrajaya and Hospital Universiti Sains Malaysia in west and east peninsular Malaysia, respectively, from February to May 2020, including Ramadan (23/4/20-23/5/20). Muslim T1DM children and adolescents who intended to fast were included. They were given structured pre-Ramadan focused education and standardised glucometers (Contour Plus One®) with glucose strips for self-monitoring of blood glucose (SMBG) at home. IPro2® (Medtronic) was used for retrospective CGM. All participants were followed up and advised to break their fast when indicated.

Results: Due to COVID-19 pandemic, out of the initial 32 participants, 8 were dropped, as 4 defaulted and another 4 had incomplete CGM pairs. Only 24 participants were analysed. Mean age was 13.6 ± 3.06 years old and mean baseline HbAlc 9.6 ± 1.85%. 91.7% were on multiple daily injections (MDI) and 8.3% on continuous subcutaneous insulin infusion (CSII). Mean basal insulin dose was 0.34 ± 0.11 unit/kg/day during Ramadan compared to 0.41 ± 0.12 unit/kg/day before. SMBG frequency was 3.8 ± 0.8 times-per-day during Ramadan and 3.9 ± 0.7 times-per-day before. All had fasted successfully for at least 7 days during CGM period and none had required emergency visits or hospitalisations. Total sensor readings were 1613.9 ± 416.1 during Ramadan and 1739.8 ± 366.9 before. Mean absolute relative difference (MARD) was 15.0 ± 9.45% during Ramadan and 14.3 ± 7.69% before. Further CGM analysis had indicated increases in time in non-severe hyperglycaemia (level 1; >10 mmol/l), mean sensor glucose and estimated A1c during Ramadan fasting as compared to the non-fasting period before. However, no difference was observed between both periods for time in severe hyperglycaemia (level 2; >13.9 mmol/l), time in mild hypoglycaemia (level 1; <3.9 mmol/l), time in severe hypoglycaemia (level 2; <3.0 mmol/l) and time in range (level 1; 3.9-10.0 mmol/l).

Conclusion: Muslim T1DM children and adolescents who were given pre-Ramadan focused education and compliant to SMBG could fast safely during Ramadan without short-term glycaemic deterioration, except for the increase in non-severe hyperglycaemia that reflects the general approach taken to buffer the greater concern of hypoglycaemia.