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Comparison of Insulin Pump Therapy and Multiple Daily Injections Insulin Regimen in Patients with Type 1 Diabetes During Ramadan Fasting.
Diabetes Technol Ther. 2017 06; 19(6):349-354.DT

Abstract

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.

Authors+Show Affiliations

1 Department of Medicine, Imam Abdulrahman Bin Faisal National Guard Hospital , Dammam, Saudi Arabia .2 Department of Medicine, King Abdulaziz National Guard Hospital , Alhasa, Saudi Arabia .3 Department of Medicine, King Abdulaziz National Guard Hospital, King Abdullah International Medical Research Center , Alhasa, Saudi Arabia .4 Department of Medicine, King Abdulaziz Medical City , Riyadh, Saudi Arabia .4 Department of Medicine, King Abdulaziz Medical City , Riyadh, Saudi Arabia .5 Biostatistics Unit, King Abdullah International Medical Research Center , Alhasa, Saudi Arabia .6 Department of Medicine, Hamad Medical Corporation , Doha, Qatar .

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28296467

Citation

Alamoudi, Reem, et al. "Comparison of Insulin Pump Therapy and Multiple Daily Injections Insulin Regimen in Patients With Type 1 Diabetes During Ramadan Fasting." Diabetes Technology & Therapeutics, vol. 19, no. 6, 2017, pp. 349-354.
Alamoudi R, Alsubaiee M, Alqarni A, et al. Comparison of Insulin Pump Therapy and Multiple Daily Injections Insulin Regimen in Patients with Type 1 Diabetes During Ramadan Fasting. Diabetes Technol Ther. 2017;19(6):349-354.
Alamoudi, R., Alsubaiee, M., Alqarni, A., Saleh, Y., Aljaser, S., Salam, A., & Eledrisi, M. (2017). Comparison of Insulin Pump Therapy and Multiple Daily Injections Insulin Regimen in Patients with Type 1 Diabetes During Ramadan Fasting. Diabetes Technology & Therapeutics, 19(6), 349-354. https://doi.org/10.1089/dia.2016.0418
Alamoudi R, et al. Comparison of Insulin Pump Therapy and Multiple Daily Injections Insulin Regimen in Patients With Type 1 Diabetes During Ramadan Fasting. Diabetes Technol Ther. 2017;19(6):349-354. PubMed PMID: 28296467.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of Insulin Pump Therapy and Multiple Daily Injections Insulin Regimen in Patients with Type 1 Diabetes During Ramadan Fasting. AU - Alamoudi,Reem, AU - Alsubaiee,Maram, AU - Alqarni,Ali, AU - Saleh,Yousef, AU - Aljaser,Saleh, AU - Salam,Abdul, AU - Eledrisi,Mohsen, Y1 - 2017/03/15/ PY - 2017/3/16/pubmed PY - 2018/3/27/medline PY - 2017/3/16/entrez KW - Continuous glucose monitoring KW - Fasting KW - Insulin pump KW - Multiple daily injections KW - Ramadan KW - Type 1 diabetes SP - 349 EP - 354 JF - Diabetes technology & therapeutics JO - Diabetes Technol Ther VL - 19 IS - 6 N2 - 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. SN - 1557-8593 UR - https://www.unboundmedicine.com/medline/citation/28296467/Comparison_of_Insulin_Pump_Therapy_and_Multiple_Daily_Injections_Insulin_Regimen_in_Patients_with_Type_1_Diabetes_During_Ramadan_Fasting_ L2 - https://www.liebertpub.com/doi/10.1089/dia.2016.0418?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -