Blood Glucose Fluctuation During Ramadan Fasting in Adolescents With Type 1 Diabetes: Findings of Continuous Glucose Monitoring

Kaplan, Walid; Afandi, Bachar

doi:10.2337/dc15-1108

Cited by 50 publications

(61 citation statements)

References 5 publications

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“…In the current study, most of the participants with T1DM fasted more than half of the Ramadan period 13. Participants on insulin pump can easily adjust the basal rate during fasting hours compared to those on MDI.…”

Section: Discussionmentioning

confidence: 92%

“…The mean result of estimated HbA1C at the beginning of the study was 8.16 ± 1.64%, whereas the estimated HbA1C at the end of the study was 8.2 ± 1.63% ( p =0.932).The diabetologist should adjust the basal rate of the insulin pump according to blood glucose variability, which is shown in the FreeStyle ® Libre™ records 13. The FGMS as a non-invasive monitoring method during fasting and non-fasting hours may recognize hyperglycemic events, and even postprandial and asymptomatic hypoglycemia 15.…”

Section: Discussionmentioning

confidence: 99%

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Flash glucose monitoring system may benefit children and adolescents with type 1 diabetes during fasting at Ramadan

Al-Agha

Kafi

Aldeen

et al. 2017

SMJ

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Objectives:To assess the benefit of using the flash glucose monitoring system (FGMS) in children and adolescents with type 1 diabetes mellitus (T1DM) during Ramadan fasting.Methods:A prospective pilot study of 51 participants visited the pediatric diabetes clinic at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia from between June until and July 2016. The FreeStyle® Libre™ FGMS (Abbott Diabetes Care, Alameda, CA, USA) was used. Hypoglycemia was defined as glucose values of less than 70 mg/dL, while hyperglycemia as glucose values of more than 150 mg/dL for all participants based on our institute’s protocol.Results:Participants were able to fast for 67.0% of the total days eligible for fasting, whereas they did not fast on 33% of the days due to either hypoglycemia (15.4%) or non-diabetes-related reasons (17.6 %). None of the participants developed severe hypoglycemia. The mean number of hyperglycemic episodes during fasting hours was 1.29, per day, which was higher than that of hypoglycemic episodes (0.7). None of the participants developed diabetic ketoacidosis (DKA). Glycemic control with mean of estimated hemoglobin A1C reading during Ramadan (8.16 ± 1.64% [pre study]) to 8.2 ± 1.63% [post study] p=0.932.Conclusions:Children and adolescents with T1DM who use the FGMS could fast without the risk of life-threatening episodes of severe hypoglycemia (namely seizure, coma), or DKA during Ramadan. Adequate education and good glycemic control prior to Ramadan are important strategies in combination with the use of an FGMS to achieve better outcome.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Flash glucose monitoring system may benefit children and adolescents with type 1 diabetes during fasting at Ramadan

Al-Agha

Kafi

Aldeen

et al. 2017

SMJ

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“…In general, patients with T1DM who have any of the following conditions must not fast [8,58] Those who insist on fasting must be aware of all the potential risks associated with fasting and must have close medical supervision [58]. A Ramadan study using CGM found that some patients experienced significant periods of hypoglycaemia while fasting, without being aware of the problem [59]. Patients are advised to test their blood glucose levels regularly throughout the fasting period (Fig.…”

Section: Adults With T1dmmentioning

confidence: 99%

“…There have been a number of studies, albeit with a limited number of patients, that have investigated fasting in adolescents with T1DM. No severe hypoglycaemic episodes have been observed, but significant periods of hypoglycaemia during fasting hours have gone unnoticed by the patient [59,[65][66][67][68] (Table S2 in supplementary information). The general consensus is that fasting should be avoided due to the observation of unrecognised hypoglycaemia.…”

Section: Young Adults/adolescents With T1dmmentioning

confidence: 99%

Diabetes and Ramadan: Practical guidelines

Hassanein

Alarouj

Hamdy

et al. 2017

Diabetes Research and Clinical Practice

275

357

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“…In one study using CGM in patients with diabetes on insulin pump treatment, no difference in hypoglycaemic episodes could be seen during daytime and night-time [4]. Kaplan et al on the other hand reported significantly higher rates of hypoglycaemia during daytime compared to night-time [2]. …”

Section: Introductionmentioning

confidence: 99%

Initial increase in glucose variability during Ramadan fasting in non-insulin-treated patients with diabetes type 2 using continuous glucose monitoring

Aldawi

Darwiche

Abusnana

et al. 2018

Libyan Journal of Medicine

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There are no studies evaluating the glucose variability in different periods of Ramadan fasting in patients with type 2 diabetes using continuous glucose monitoring (CGM). This study examined the effect of Ramadan fasting on interstitial glucose (IG) variability in early,- late-, and post-Ramadan compared to pre-Ramadan days in non-insulin-treated type 2 diabetes patients. Participants had a CGM system connected 2 or 3 days before Ramadan start, which was removed on the third or fourth day of Ramadan. CGM performance continued for a total of 6 days. A second CGM performance started on the 27th or 28th day of Ramadan and ended on the 4th or 5th post-Ramadan day. First, CGM recordings were divided into pre-Ramadan and early-Ramadan CGM, and second recordings into late-Ramadan and post-Ramadan. At each visit, blood pressure, body weight, and waist circumference were measured, and fasting blood samples were collected for HbA1c and plasma glucose. All patients received recommended Ramadan education before Ramadan. Thirty-three patients (mean age 55.0 ± 9.8 years, 73% males) were prospectively included. IG variability, estimated as mean amplitude of glycaemic excursions (MAGE), increased significantly in early-Ramadan compared to pre-Ramadan (P = 0.006) but not in late-Ramadan and post-Ramadan recording days. Only patients on >2 anti-diabetic drugs (n = 16, P = 0.019) and those on sulphonylureas (n = 14, P = 0.003) showed significant increase in MAGE in early-Ramadan. No significant changes were seen in coefficient of variation, time in range, time in hyperglycaemia, or time in hypoglycaemia. Except for an initial increase in glucose variability, fasting Ramadan for patients with non-insulin-treated type 2 diabetes did not cause any significant changes in glucose variability or time in hypoglycaemia during CGM recording days compared to non-fasting pre-Ramadan period.

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Blood Glucose Fluctuation During Ramadan Fasting in Adolescents With Type 1 Diabetes: Findings of Continuous Glucose Monitoring

Cited by 50 publications

References 5 publications

Flash glucose monitoring system may benefit children and adolescents with type 1 diabetes during fasting at Ramadan

Flash glucose monitoring system may benefit children and adolescents with type 1 diabetes during fasting at Ramadan

Diabetes and Ramadan: Practical guidelines

Initial increase in glucose variability during Ramadan fasting in non-insulin-treated patients with diabetes type 2 using continuous glucose monitoring

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