1. Baseline characteristics
Incidence of Hypoglycemia in Type1 Diabetes Patients who fast Ramadan; Insulin Pump Compared to Multi-Dose Injection using Insulin Glargine and Aspart
Drs. Reem Al Amoudi *, Maram AlSubaiee , Ali Al Qarni , Yousef Saleh , Saleh Aljaser , Waleed AlTamimi and AbdulSalam
Endocrinology Section, National Guard Health Affairs, King Abdullah International Medical Research Center , KSA
Introduction
Fasting the holy month of Ramadan is associated with risk of hypoglycemia and other acute glycemic disturbances.
Though exempt from fasting many patients with type1 diabetes (T1DM) choose to fast.
The effect of fasting during Ramadan on rate of hypoglycemia is not known with certainty and managing T1DM during fasting is very challenging.
Very few studies have documented the safety and efficacy of different insulin regimens on fasting.
Continuous subcutaneous insulin infusion (CSII) management offers the advantage of flexibility and precision to administering insulin and has been proven to reduce severe hypoglycemia compared to multi-dose insulin injection (MDI).
Objective
Primary Objective :
To determine if insulin pump users have less rates of hypoglycemia during fasting Ramadan compared to MDI users [Hypoglycemia defined as blood glucose level ≤ 70 mg/dl ( 3.9 mmol/l)]
Secondary Objectives:
To estimate the difference between the two groups in:
Number of days they needed to brake their fast due to acute complications (hypoglycemia, severe hyperglycemia or DKA).
Glycemic control.  
Overnight hyperglycemia.
Rate of severe hyperglycemia and /or DKA.
Methods
A small cohort of patients with T1DM above the age of 14-years on either CSII or MDI, and who fast Ramadan were recruited from three diabetes/ Endocrine clinics in three different cities in Saudi Arabia (Dammam, Alahsa and Riyadh).
Demographic data and data on glycemic control were collected before, during, and after Ramadan using questionnaire , glucometer ( SMBG ) and continues glucose monitoring (CGM) data
Methods
Results
Results .
Results
Study flow chart
Baseline characteristics
Conclusions
Fasting Ramadan is well tolerated in patients with T1DM on both MDI and Pump therapy with no major complications
Although mild hypoglycemia is more in pump , MDI is associated with higher rate of sever hypoglycemia and number of days needed to break fasting.
Glycemic control ( as indicated by A1c ) was generally better in Pump than MDI , but it worsened with fasting in both groups
Acute diabetes complications requiring hospitalization are very rare and in our study only occurred in two patients on MDI group
Funding Institution : King Abdullah International Medical Research Center
PI contact * :
References
Ali G, Fasting of persons with diabetes mellitus during Ramadan. Diabetologia Croatica, 2002
Al-Arouj M Recommendations for Management of Diabetes During Ramadan , 2010
Colquitt JL, Clinical and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes. 2004