Impact Of Optimum Diabetes Care On Safety Of Fasting Ramadan In Patients With Gestational Diabetes

Download or read book Impact of Optimum Diabetes Care on Safety of Fasting Ramadan in Patients with Gestational Diabetes written by Abuelkheir Sona and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Impact of Optimum Diabetes Care on Safety of Fasting Ramadan in Patients with Gestational DiabetesAuthors:Mohamed Hassanein, Sona Abuelkheir, Manal Twair, Alaaeldin Basheir, Fauzia Rashid, Maryam Al Saeed, Fatima Alsayyah, Fawzi Eltayb, Mohammed Abdellatif, Elamin Abdelgadir ,Azza Khalifa, Fatheya AlawadiBackground: Fasting during Ramadan, is obligatory for all healthy adult Muslims. Many people are exempt from fasting including pregnant women. Indeed, all guidelines consider women with gestational diabetes (GDM) as high-risk group and are advised against fasting. However, many women with GDM insist on fasting in spite of the advice given.Management of GDM is dependent on avoiding postprandial hyperglycaemia as well as hypoglycaemia. However, there is paucity of data looking into GDM management during Ramadan.The use of any type of continuous glucose monitoring (CGM) was not previously evaluated during Ramadan for GDM.This study was approved by our local ethics committee to better understand the safety of fasting for women with GDM who insist on fasting Ramadan.Aim: The primary objective is to study the safety of fasting in patient with GDM in Ramadan in terms of glycemic fluctuations and changes in biometric and biochemical parameters before and after Ramadan.Methods: 25 women with GDM insisting on fasting received optimum care for their diabetes control during Ramadan as follows:u2022tCGM monitoring with Freestyle Libre covering a duration of 6 weeks to include time before, during and after Ramadan. u2022tRamadan and diabetes focused education session. u2022tTreatment was adjusted as per guidelines u2022tAttendance of diabetes antenatal clinics every 1-2 weeks. u2022tBiometric and biochemical data were measured 2-4weeks before and after RamadanResults and Discussion: 72% were emirate; mean gestational age was 26.48 weeks. 66% fasted 21-30 days, 32% were treated with diet only, 48% with metformin only and 20% with insulin and metformin.Data comparing pre to post-Ramadan showed that mean weight increased by 1 kg while there was no significant change in blood pressure or e-GFR. Lipids parameters showed some increase where total cholesterol increased from 133.2 to 151.4 mg/dl, LDL increased from 238 to 248 mg/dl and triglyceride increased from 225 to 267 mg/dl. Mean Fructosamine was unchanged while HbA1c showed slight improvement from 6% to 5.5%. Average number of hypoglycemic events during Ramadan showed increment from 5 to 9 when compared to non-Ramadan. The duration between 12-18hours showed the highest incidence of hypoglycaemic events. The frequency of hypoglycaemic events showed the following:0 events: 2 in Ramadan and 1 in non-Ramadan1-5 events: 3 in Ramadan and 14 in non-Ramadan6-10 events: 6 in Ramadan and 6 in non-Ramadan10-15 events: 8 in Ramadan and 3 in non-Ramadan>15 events: 6 in Ramadan and 1 in non-RamadanThose treated with diet only had 85 hypoglycaemic events in Ramadan and 30 events in non-Ramadan period, those on metformin only had 140 events in Ramadan versus 47 events in non-Ramadan, while those treated with insulin and metformin had 24 events in Ramadan vs 16 events in non-Ramadan. Few patients were using SMBG at the same time as free style Libre. In those who did, hyoglycaemia was confirmed in 3 patients on diet, 7 patients on metformin and 2 for those on insulin with metformin. 16% had no postprandial hyperglycemia (>120mg/dl) after iftar, 64% had 1 to 5 events, 12% had 6 to 10 events and 8% had more than 10 events. None needed admission for any reason.Conclusion:Many women with GDM fasted in Ramadan. However, hypoglycaemic events increased significantly during Ramadan fasting even for those on diet only or in those treated with metformin while assessed by free style Libre. The time between 12-18 hours had the highest incidence of hypoglycemic episodes. With the exception of lipids profile, there was no significant change in biochemical or biometric parameters. None was admitted to hospital. This data are of important clinical implications and need to be repeated again with a larger cohort and with clear advice to re-check with SMBG if results indicate hypoglycaemia to confirm it and to assess the accuracy of free style Libre and or any other CGM in pregnant women with GDM during fasting Ramadan.