ESPE Abstracts

Background: Fasting during Ramadan, starting daily before sunrise and ending at sunset, with traditional rich meals at "Sohoor" (pre-dawn) and "Fotoor" (evening break of fast). is common among Muslims from 8 years of age. Recent use of the closed loop automated insulin delivery system (CLAIDS) including insulin pump and glucose sensor has become staple treatment of type 1 diabetes (T1D) patients and reported to safely manage glucose fluctuations in Ramadan. In this study we aimed to assess hypoglycemic episodes (Low<70 and Very low <55 mg/dl) during fasting hours and hyperglycemic fluctuations throughout the month of Ramadan in T1D patients using CLAIDS.

Methods: An Observational study included 16 T1D patients (ages 10-19y) with CLAIDS (Medtronic 780). Glucose monitoring data (every 5 minutes) was recorded prior, during and after Ramadan. Glucose levels, trends and adverse events were assessed by comparing between non fasting (NFP) and the fasting periods (FP) of each patient.

Results: Trends of increased incidence of hypoglycemic events, which did not reach statistical significance, were observed in the fasting hours of the FP when compared to the NFP prior to Ramadan. Interestingly, hypoglycemic glucose levels in the NFP after Ramadan decreased significantly compared to both NFP prior to Ramadan and to Ramadan - though with low effect size. Patients who failed to complete full fasting weeks had more hypoglycemic events during FP weeks 1-3 (P <0.001) and more Very low events during all FP weeks (P <0.001). Looking at glucose levels “time in range” (TIR) in non-fasting hours in evening- “Fotoor” (6-11 pm) pre-fast morning period - “Sohoor” (11pm-4am) showed a significantly lower TIR in the FP compared to the NFP. Namely, TIR during FP “fotoor” was 49.82% compared to NFP 67.9%, P < 0.0001. TIR during FP “Sohoor” (45.16%) compared to NFP 48.19%, P < 0.0001. Mean glucose levels (MGL) during FP "Fotoor” (188 MG%) and "Sohoor" (201 MG%) increased significantly compared to NFP "Fotoor" (162 MG%) and Sohoor (190 MG%) (P <0.001 and P <0.01 respectively).

Conclusion: CLAIDS handles safely hypoglycemic episodes during Ramadan fasting. However, a significant decrease in the TIR% and significant increase in MGL is seen during the daily re-feeding hours. These might be corrected with an increase in Insulin/Carbohydrate ratio for Ramadans’ ‘fotoor and sohoor’ and a special “education-kit” on Carbohydrate counting of foods typical for Ramadan.