SUN-160 Insulin Glargine Time of Injection during Fasting Ramadan in Patients with Type 1 Diabetes

Abstract

Introduction: Fasting Ramadan carries high risk for patients with T1DM. Current IDF-DAR guidelines suggest to change basal insulin timing from bedtime to early evening. However, there is paucity of studies to guide physicians toward evidence based management decisions. Objective: To compare glucose profiles in patients with T1DM while taking basal insulin Glargine at 7 pm (after Maghreb) versus 12 midnight (bed time) during Ramadan. The primary outcome being rates of hypoglycemia. Methods: 30 patients with T1DM planning on fasting Ramadan were recruited from the Diabetes clinic at Imam Abdulrahman bin Faisal Hospital National Guards Hospital, Dammam, Saudi Arabia. Glucose data collected using self-monitoring via the Abbott Freestyle Libre © 14-day device. Patients were instructed to continue taking their insulin glargine at bedtime for two weeks of Ramadan then to change timing to 7pm for the other two weeks of Ramadan in a treatment timing cross-over design. Results: Out of the 30 patients recruited 19 completed both phases of the study. Total number of sensor data captured was 79.84 for the 7pm timing vs. 72.82 for the 12am timing, and the total daily scans recorded were 9.79 vs. 8.18 respectively. The percentage of time spent within target (70-180mg/dl) for the 7pm timing vs. the 12 am timing respectively was 24.53% vs. 21.24%, above target 63.31% vs. 65.76%, and below target 12.16% vs. 13%. The average blood glucose for the 7pm timing vs. for the 12 am timing was 193.63 mg/dl vs 198.59 mg/dl and the HbA1c for the two weeks as calculated by Abbott Libre software was 8.24 vs 8.34% (p more than 0.05 for all values). Average number of hypoglycemic episodes (<70mg/dl) was 9.3 during the 7pm timing vs. 8.1 during the 12 am timing (p=0.05), and average duration spent in hypoglycemia was 128.3 minutes vs. 125.8 minutes (p=0.89). Conclusion: In patients with T1DM who fast Ramadan there is no advantage of changing basal insulin Glargine timing to earlier evening hours in regards to difference in rates of hypoglycemia. Larger randomized trials are needed to answer this question.