A pilot study using flash continuous glucose monitoring in patients with type-2 diabetes on multiple anti-diabetic agents during Ramadan

Bashir, Mohammed; Elhadd, Tarik; Ali, Hamda; Baagar, Khaled; Hakam, Ibrahim A. Abdel; Al-Mohanadi, Dabia; Naem, Emad; Abdulla, Amina Al; Mohammed, Kawsar; Abou-Samra, Abdul-Badie

doi:10.1016/j.dsx.2018.06.005

Cited by 13 publications

(11 citation statements)

References 11 publications

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“…However, in combination during Ramadan, the risk of hypoglycaemia might be increased. Indeed, we have shown in a subgroup of 16 patients from our cohort utilizing CGMS technology that subclinical hypoglycemia is highly prevalent in such patients [22]. Patients from an Arab background were at higher risk compared to the Qatari population in this cohort.…”

Section: Discussionmentioning

confidence: 62%

“…The increased risk of hypoglycaemia is likely due to the difference in activity during the fasting hours. In a subgroup analysis of 16 subjects from this cohort, we have shown that active patients during Ramadan have more episodes of hypoglycaemia compared to sedentary patients [22]. The combination of metformin, DPP-IV inhibitors and basal insulin was associated with significantly higher risk of hypoglycaemia compared to other combinations, yet due to the small number in this group, this finding warrants further studying.…”

Section: Discussionmentioning

confidence: 72%

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Incidence of hypoglycaemia in patients with type-2 diabetes taking multiple glucose lowering therapies during Ramadan: the PROFAST Ramadan Study

Elhadd

Dabbous

Bashir

et al. 2018

J Diabetes Metab Disord

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Objective To assess the incidence of hypoglycemia in people with type-2 diabetes mellitus (T2DM) on three or more antidiabetic medications during Ramadan. Study design methods We have studied people with T2DM on three or more glucose-lowering drugs during Ramadan of H1438 (May-June 2017). The dose of each drug was adjusted according to a pre-specified protocol. The incidence of symptomatic or blood glucose confirmed hypoglycemia was recorded during the study. Results We enrolled 228 people with T2DM; 181 completed the study, and data on hypoglycaemia was available in 172 subjects. There were 115 males and 66 females, (mean age ± SD) 53.6 ± 9.7 years, diabetes duration 10 ± 6 yrs. The incidence of hypoglycaemia was 16.3% (28/172). Univariable logistic regression analysis showed that the risk of hypoglycaemia was increased in Arab subjects compared to Qatari; in those with longer duration of diabetes; and in those on four or more antidiabetic medications compared to those on three anti-diabetic medications. Conclusion Despite the tailored advice, there is a high incidence of hypoglycemia in people with T2DM taking multiple glucose lowering therapies whilst fasting during Ramadan. Guidelines should address the increased complexity in anti-diabetic medications in patients who fast during Ramadan. Healthcare providers should individualize the modifications in anti-diabetic medications during Ramadan.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 72%

Incidence of hypoglycaemia in patients with type-2 diabetes taking multiple glucose lowering therapies during Ramadan: the PROFAST Ramadan Study

Elhadd

Dabbous

Bashir

et al. 2018

J Diabetes Metab Disord

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“…Another study showed that patients on more than three anti-diabetes medications, especially when physically active, had a higher risk of asymptomatic hypoglycemia during fasting [31]. They suggested that flash glucose monitoring systems could be protective against this, although this does require a level of patient engagement which can limit its efficacy [31]. The advent of "alarmed" glucose monitoring sensors may become tools which can facilitate safe fasting even in patients at higher risk of hypoglycemia and therefore potentially remove lifestyle restrictions that result from diabetes [19,31].…”

Section: Discussionmentioning

confidence: 99%

“…Whilst patients on more than two anti-diabetes medications or sulfonylureas showed an increased risk of hypoglycemia in that study [ 29 ], a larger study showed no association with sulfonylurea use with increases in hypoglycemia [ 30 ]. Another study showed that patients on more than three anti-diabetes medications, especially when physically active, had a higher risk of asymptomatic hypoglycemia during fasting [ 31 ]. They suggested that flash glucose monitoring systems could be protective against this, although this does require a level of patient engagement which can limit its efficacy [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Continuous Glucose Monitoring of Glycemic Variability During Fasting Post-Sleeve Gastrectomy

et al. 2020

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Introduction Day-long fasting creates considerable metabolic stress that poses challenges in people with diabetes and those who have undergone bariatric surgery. Clinical knowledge of glucose fluctuations and the risks for such patients during fasting is limited. Objectives This study examined the effect of intermittent fasting on glucose excursions, hypoglycemia, and hyperglycemia in people with or without diabetes who had sleeve gastrectomy compared with healthy individuals. Methods This open-label, prospective study compared interstitial glucose profiles measured with continuous glucose monitoring system for 72 h during fasting and non-fasting periods between four groups comprising 15 participants each: people with obesity and medicine-treated type 2 diabetes (T2D) only, obesity and T2D treated with sleeve gastrectomy, obesity without T2D treated with sleeve gastrectomy, and healthy, normal-weight non-diabetic controls. Results The mean 72-h glucose concentration was significantly lower during the fasting period for all groups (p ≤ 0.041), with the highest glucose concentrations in the medicine-treated T2D-only group and the lowest concentrations in the sleeve gastrectomy in non-T2D group. The mean glucose profiles of all the groups showed a marked increase in interstitial glucose on breaking the fast, which was exaggerated in the two diabetes groups. The mean amplitude of glycemic excursions did not differ significantly within each group between fasting and non-fasting. No significant difference was noted in the fraction of time in the hypoglycemic range between the fasting and non-fasting periods in any group. Conclusion Intermittent fasting had no adverse effect on glycemic control in people with or without diabetes who had undergone sleeve gastrectomy.

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“…Professional CGM systems have been used clinically to measure the effects of variables over an intermittent or specific time interval, such as 3 days or 2 weeks. More specifically, such CGM has been used to evaluate the effects of various interventions, behaviors, and therapies, including the effects of foods or various types of exercise and medication titration (4)(5)(6)(7).…”

mentioning

confidence: 99%

Using Continuous Glucose Monitoring in Clinical Practice

Miller¹

2020

Clinical Diabetes

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Continuous glucose monitoring is poised to radically change the treatment of diabetes and patient engagement of those afflicted with this disease. This article will provide an overview of CGM and equip health care providers to begin integrating this technology into their clinical practice.Continuous glucose monitoring (CGM) systems are more than just glucose monitors. Recent CGM systems have moved beyond mere blood glucose monitoring (BGM) by providing both real-time and predictive glycemic data. The robust data garnered from CGM can also be used for detection of trends, identification of asymptomatic events, and review of glycemic variability over a range of time.

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A pilot study using flash continuous glucose monitoring in patients with type-2 diabetes on multiple anti-diabetic agents during Ramadan

Cited by 13 publications

References 11 publications

Incidence of hypoglycaemia in patients with type-2 diabetes taking multiple glucose lowering therapies during Ramadan: the PROFAST Ramadan Study

Incidence of hypoglycaemia in patients with type-2 diabetes taking multiple glucose lowering therapies during Ramadan: the PROFAST Ramadan Study

Continuous Glucose Monitoring of Glycemic Variability During Fasting Post-Sleeve Gastrectomy

Using Continuous Glucose Monitoring in Clinical Practice

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