Ramadan and diabetes: evidence-based guidelines

Empowerment-Based Diabetes Self-Management Education to Maintain Glycemic Targets During Ramadan Fasting in People With Diabetes Who Are on Conventional Insulin: A Feasibility Study

OBJECTIVE

This study aims to assess the feasibility of promoting safe Ramadan fasting through diabetes self-management education (DSME) and to determine the effect of such education on hypoglycemic episodes.

DESIGN AND METHODS

This prospective study included subjects attending Ramadan reinforcement sessions for participants in the Educational Program for People with Diabetes (EPPWD) at the Ain-Shams University Diabetes Center in Cairo, Egypt. The DSME sessions started 2-3 weeks before Ramadan and included one experimental fasting day during the first week and one during the second week. Participants' A1C and serum fructosamine levels were measured before and after Ramadan, and they completed weekly self-monitoring of blood glucose (SMBG) logs.

RESULTS

Among 21 participants who were intending to fast for Ramadan, 14 completed the program. Their mean A1C was 6.7 ± 1.6%, and SMBG results showed a statistically nonsignificant difference in mean blood glucose levels before and after Ramadan (123.84 ± 39.96 and 123.84 ± 25.92 mg/dL, respectively; P >0.05). Serum fructosamine after Ramadan declined by 10% from pre-Ramadan levels. The mean number of hypoglycemic events before Ramadan was 3 ± 1.04, which declined to 1.4 ± 0.5 during Ramadan. Differences between group 1 (those without hypoglycemia, n = 8) and group 2 (those with hypoglycemia, n = 6) were nonsignificant for all variables, including A1C.

CONCLUSION

Ramadan fasting is feasible for people with diabetes who are on a multiple daily injection insulin regimen and participate in the EPPWD. The number of hypoglycemic events per month declined with the attainment of DSME.

Effectiveness of the low-glucose suspend feature of insulin pump during fasting during Ramadan in type 1 diabetes mellitus

BACKGROUND

Severe hypoglycaemia during the daytime of Ramadan fasting is a highly feared complication. In a prospective study, we investigated the effect of the low-glucose suspend (LGS) algorithm on the frequency of hypoglycaemia in adolescents with T1DM who wished to fast during Ramadan.

SUBJECTS AND METHODS

Sixty patients (19 males and 41 females, 15.6 ± 2.7 years, duration of diabetes 5.8 ± 2.9 years, pump therapy for 1.73 ± 0.99 years, used the Paradigm(®) Veo(™) System (Medtronic) and were divided into two groups: first (n=25), those who used the sensor with low-glucose suspend (LGS) feature and second (n = 35), those who used the sensor but turned off low-glucose suspend (LGS) feature.

RESULTS

A total of 2716 LGS alerts occurred, and 48.6% began in the afternoon between 4pm and 7pm. The mean duration of LGS events was 26.5 min, 38% lasted for <5 min and 5.3% lasted for 120 min. Among these episodes, the mean sensor glucose was 62.3 ± 5.96 mg/dL at LGS activation, rose to 129.8 ± 11.6 mg/dL by the end of the LGS episode (when insulin delivery was automatically resumed) and was 155.6 ± 11.1 mg/dL at 240 min. LGS usage significantly reduced area under the curve (AUC) <70, AUC <60 mg/dL (p = 0.0001) and >240 mg/dL (p = 0.006). None of the LGS-on group broke their fast versus 15 in the second group (p = 0.001). No episodes of severe hyperglycaemia or DKA were noticed in either groups.

CONCLUSIONS

Usage of low-glucose suspend (LGS) significantly reduced exposure to hypoglycaemia without compromising safety. Copyright © 2016 John Wiley & Sons, Ltd.

Insulin pump therapy in Moslem patients with type 1 diabetes during Ramadan fasting: an observational report

BACKGROUND

Many Moslem patients do observe the fast during Ramadan. There are limited data on insulin pump therapy during Ramadan. We report our experience with type 1 diabetes patients on insulin pumps during Ramadan 2008 (29 days).

PATIENTS AND METHODS

A total of 63 patients were evaluated. Forty-nine patients fasted, and 14 elected not to fast. Those who fasted (24 males, 25 females) were 22 +/- 7 years of age (mean +/- SD) and had had diabetes for 9.6 +/- 5.6 years. Patients used the Medtronic (Northridge, CA) MiniMed 722 model and had been using pump therapy for 20 +/- 10 months. Outcome measures included number of days fasted, hypoglycemia, unusual hyperglycemia, and number of emergency hospital visits.

RESULTS

Thirty patients (61.2%) fasted the whole month with no problems, nine (18.4%) fasted 27-28 days, eight (16.3%) fasted 24-25 days, and two (4.1%) fasted 23 days. Nearly half of the patients decreased their basal insulin by 5-50% of their prefasting doses. Seventeen patients had hypoglycemia requiring breaking the fast. Fasting was broken on 55 out of 1,450 potential fasting days (3.8%). No severe hypoglycemia was reported by any patient. Unusual hyperglycemia was reported in nine patients (18.4%). Hospital visits were reported for one patient for hyperglycemia (a 16-year-old girl who disconnected her pump). Twelve patients had fructosamine levels measured both before and immediately after Ramadan; pre-Ramadan fructosamine level was 4.0 +/- 0.6 mmol/L, and the post-Ramadan value was 3.6 +/- 0.6 mmol/L (P = 0.007).

CONCLUSIONS

Fasting during Ramadan is feasible in patients with type 1 diabetes using an insulin pump, with adequate counseling and support.