Comparison of Insulin Pump Therapy and Multiple Daily Injections Insulin Regimen in Patients with Type 1 Diabetes During Ramadan Fasting.
INTRODUCTION
Fasting Ramadan carries a high risk for patients with type 1 diabetes (T1DM). Data on the optimum insulin regimen in these patients are limited.


OBJECTIVES
To compare glucose profiles in patients with T1DM who use continuous subcutaneous insulin infusion (CSII) compared with those who use multiple daily injections (MDI) insulin regimen during Ramadan fast. The primary outcome was rates of hypoglycemia. Other outcomes included glycemic control, number of days needed to break fasting, and acute glycemic complications.


METHODS
Patients with T1DM who were on CSII or MDI and decided to fast Ramadan were recruited. Glucose data collected using self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) were compared in the two groups, CSII and MDI, and glucose control was assessed by measuring serum fructosamine levels.


RESULTS
A total of 156 patients were recruited, 61 on CSII and 95 on MDI. There was no difference in the rate of mild hypoglycemia <4.4 mmol/L (<80 mg/dL) (8.6% ± 6.1% in the CSII group and 9.85% ± 9.34% in the MDI group, P = 0.96). The mean rate of severe hypoglycemia <2.7 mmol/L (<50 mg/dL) was also not different in both groups (0.99% ± 1.7% in the CSII group compared to 1.7% ± 4.7% in the MDI group, P = 0.23). There was no difference in glycemic control as measured by fructosamine levels or the number of days that patients have to stop fasting. Glucose variability was significantly better in CSII group (SMBG; standard deviation [SD] 66.9 ± 15.3 vs. 76.9 ± 29.9, P = 0.02) (CGM; SD 68.1 ± 19.6 vs. 78.7 ± 24.9, P = 0.04). No diabetic ketoacidosis was reported in either group.


CONCLUSION
In patients with T1DM who fast Ramadan, there was no difference in rates of hypoglycemia or hyperglycemia between CSII and MDI. However, CSII was associated with less glucose variability.
['Alamoudi|Reem|R|', 'Alsubaiee|Maram|M|', 'Alqarni|Ali|A|', 'Saleh|Yousef|Y|', 'Aljaser|Saleh|S|', 'Salam|Abdul|A|', 'Eledrisi|Mohsen|M|']
D000328:Adult D001786:Blood Glucose D015331:Cohort Studies D003922:Diabetes Mellitus, Type 1 D004334:Drug Administration Schedule D005215:Fasting D005260:Female D005500:Follow-Up Studies D006693:Holidays D006772:Hospitals, Military D006801:Humans D006943:Hyperglycemia D007003:Hypoglycemia D007004:Hypoglycemic Agents D007279:Injections, Subcutaneous D007328:Insulin D007332:Insulin Infusion Systems D007514:Islam D008297:Male D011446:Prospective Studies D012529:Saudi Arabia D055815:Young Adult
Insulin pump Multiple daily injections Type 1 diabetes Ramadan Fasting Continuous glucose monitoring