Abstract

Aims/IntroductionAlthough patients with type 1 diabetes are medically exempt, many insist on fasting during Ramadan. Multiple daily insulin injections (MDI), premixed insulin and continuous subcutaneous insulin infusion (CSII) are commonly used. To date, little is known about the safety of Ramadan fasting in these patients.Materials and MethodsWe pooled data from 17 observational studies involving 1,699 patients treated with either CSII or non‐CSII (including premixed and MDI) regimen. The study outcomes were the frequencies of hypoglycemia, hyperglycemia and/or ketosis. Given the lack of patient‐level data, separate analyses for premixed and MDI regimen were not carried out.ResultsThe CSII‐treated group (n = 203) was older (22.9 ± 6.9 vs 17.8 ± 4.0 years), and had longer diabetes duration (116.7 ± 66.5 vs 74.8 ± 59.2 months) and lower glycated hemoglobin (7.8 ± 1.1% vs 9.1 ± 2.0%) at baseline than the non‐CSII‐treated group (n = 1,496). The non‐CSII‐treated group had less non‐severe hypoglycemia than the CSII‐treated group (22%, 95% CI 13–34 vs 35%, 95% CI 17–55). Of the non‐CSII‐treated group, 7.1% (95% CI 5.8–8.5) developed severe hypoglycemia, but none from the CSII‐treated group did. The non‐CSII‐treated group was more likely to develop hyperglycemia (12%, 95% CI 3–25 vs 8.8%, 95% CI 0–31) and ketosis (2.5%, 95% CI 1.0–4.6 vs 1.6%, 95% CI 0.1–4.7), and discontinue fasting (55%, 95% CI 34–76 vs 31%, 95% CI 9–60) than the CSII‐treated group.Conclusions The CSII regimen had lower rates of severe hypoglycemia and hyperglycemia/ketosis, but a higher rate of non‐severe hyperglycemia than premixed/MDI regimens. These suggest that appropriate patient selection with regular, supervised fine‐tuning of the basal insulin rate with intensive glucose monitoring might mitigate the residual hypoglycemia risk during Ramadan.

Highlights

  • Ramadan fasting is one of the five pillars of Islam and is obligatory for all healthy Muslim adults[1]

  • The present meta-analysis reported that young patients with suboptimally-controlled type 1 diabetes mellitus and treated with continuous subcutaneous insulin infusion (CSII) regimen undertook Ramadan fasting with lower rates of hyperglycemia, ketosis and breaking fast compared with those treated with either premixed insulin or Multiple daily insulin injections (MDI) regimen

  • One possibility was the CSII-treated group had a lower pre-Ramadan HbA1c than the non-CSII-treated group (7.8% vs 9.1%), and the CSII-treated group might be more prone to hypoglycemia during prolonged fasting

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Summary

Introduction

Ramadan fasting is one of the five pillars of Islam and is obligatory for all healthy Muslim adults[1]. In patients with diabetes mellitus, the fine adjustments of glucose homeostasis during fasting through glycogenolysis and gluconeogenesis with a concurrent rise in circulating glucagon and a fall in insulin level are lost, especially among those with type 1 diabetes mellitus[3]. These patients are unable to mount an appropriate hormonal response to handle a state of prolonged nutrition deprivation[4].

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