Impact Of Optimum Diabetes Care On The Safety Of Fasting In Ramadan In Adult Patients With Type 1 Diabetes Mellitus

Download or read book Impact of Optimum Diabetes Care on the Safety of Fasting in Ramadan in Adult Patients with Type 1 Diabetes Mellitus written by Al Saeed Maryam and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: BackgroundIslamic law exempts patients with poor health from fasting duringRamadan. Some of our patients with type 1 diabetes are eager forRamadan fasting against medical advice and religious exemption.Current recommendations stratify this subgroup of patients as highrisk for fasting though the published data is sparsely available inthis regard.AimThe primary objective is to assess the safety of Ramadan fasting inpatients with type 1 diabetes by monitoring the rate and severity ofhypoglycemia and hyperglycemia during the fasting period and compareit with the non-fasting state.The secondary endpoint is to follow the effect of fasting on theirweight, blood pressure, and HbA1c by observing these parameters preand post Ramadan.MethodPatients with a known diagnosis of type 1 diabetes mellitus attendingthe Adult Endocrinology Clinic at Dubai Hospital were selected atconvenience 1-2 months before Ramadan, counselled, and asked to signan informed consent. Patients with concurrent renal disease or anyrecent hospitalisation in the last 3 months were excluded. All thepatients received a 90 minutes session for Ramadan-focused education.The Freestyle Libre flash sensor insertion was done for continuousglucose monitoring. Their biophysical and biochemical profile wascollected 2 to 4 weeks before and after Ramadan. We recorded diabetesrelated emergency visits or hospitalisation, change in BMI, systolicand diastolic BP, lipids profile, renal function, HBA1c, and frequencyof hypoglycemia during Ramadan fasting and non-fasting period.All the quantitative values are described as mean, and analysis of CGMdata is shown in frequencies.Results and DiscussionA total of 30 patients with type 1 diabetes were recruited, 4 patientsdropped out, 1 of which was due to a hospitalization with diabeticketoacidosis. 4 other patients did not complete the full protocol asthey only had one sensor. There were 26 patients in total with CGMdata available. 53% were male and 47% female with a mean age of 23.3yrs u00b17.85. The average duration of diabetes was 8.6 years. Themajority of patients were on basal bolus insulin with the exception of2 who were on an insulin pump. 21% reported fasting the entire monthof Ramadan with 24 days being the average number of days fasted.A total of 258 days of non-fasting data was recorded (47%) and 289days of fasting data in Ramadan (53%). 46.7% of patients had frequenthypoglycemic events of >10 episodes in 2 weeks during the non-fastingperiod compared to 29.2% who had a similar frequency of hypoglycemia(HE) during Ramadan. There was no difference between the percentage ofpatients who had 2-9 episodes of hypoglycemia with 50% of patients inboth groups. More patients had no HE recorded at all on CGM in theRamadan group (12.5%) compared to the non fasting period (8.3%). 79%of patients had a glucose reading below 49 mg/dl in the non-fastingperiod compared to 66.7% during Ramadan. The average duration of HEwas slightly longer during Ramadan with a mean of 98.50 minutes u00b162.55compared to 96.33 minutes u00b149.32 in the non-fasting period. Most HEoccurred between 00:00-06:00 (average 2.57 per/day) and the least HEoccurred between 06:00-12:00 (average 1.78 per/day) in the non-fastingperiod. During Ramadan, most HE occurred between 00:00-06:00 (average2.08 per/day) and the least events occurred between 12:00-18:00(average 1.29 per/day). 62% of patients improved in Ramadan by havingless HE, 9.5% remained the same, and 33.3% had more frequent HE duringRamadan. The mean average glucose around Iftar time was 181.1 mg/dlu00b158 and the mean glucose 2 hours later was 231.0 mg/dl u00b166.The average lab HbA1c pre Ramadan was 8.23% and 7.89% post Ramadan.Pre-Ramadan weight was 70.16 kg u00b1 17.92 and 69.61 kg u00b1 16.70post-Ramadan. Systolic blood pressure was 116.31 mmHg u00b1 15.45 beforeRamadan and 116.13 mmHg u00b1 12.25 post-Ramadan. Diastolic blood pressurewas 69.7 mmHg u00b1 7.46 before Ramadan and 66.31 mmHg u00b1 10.1post-Ramadan.ConclusionOptimum care for type 1 diabetes resulted in favorable glycemiccontrol after Ramadan fasting with less hypoglycemic episodes duringRamadan compared to non-fasting days. Biometric and biochemical dataremained the same, with a minor trend of improvement and there was anegligible hospitalization rate. Replication of the study in a largercohort is essential before clinical application.