Can People with Type 1 Diabetes using AID technology fast safely during Ramadan ?
D-coding the Article - A Real-World Prospective Study of the Effectiveness and Safety of Automated Insulin Delivery Compared with Other Modalities of Type 1 Diabetes Treatment During Ramadan Intermittent Fasting
Published Date:
28th February 2024
Published By:
Mohammed E. Al-Sofiani, Sahar Alharthi, Sarah Albunyan, Naweed Alzaman, David C. Klonoff, Abdullah Alguwaihes
Approved By:
Mohammed E. Al-Sofiani
Decoded By:
Asra H. Ahmed
MBA, PGCE in Assessment Learning disability, Diabesties Foundation
10 mins to read
- The T1D Takeaway
- It is possible for people living with type 1 diabetes to fast. It is worth spending extra for an Automated Insulin Delivery (AID) system.
- The results can be transposed to other types of fasts around the world. Based on the findings, these insights can be transferred to other forms of fasting.
Word Wizard
- This study was carried out during (2 April-2May) Ramadan 2022, fasting hours ranged from 13.5 to 14.3 hours.
- 294 people with type 1 diabetes from five medical centers in Riyadh and Madinah, Saudi Arabia participated.
- Glycemic Control: AID users had the best glycemic control, with the highest Time in Range (TIR), and lowest Time Below Range (TBR) or Time Above Range (TAR).
- Participants using AID were able to fast twice as many days from sunrise to sunset compared to those using systems other than AID systems.
- AID systems are highly effective and safe for managing diabetes during Ramadan fasting, outperforming other treatment methods.
- Clinical Implications: The study supports the superiority of AID technology and suggests updating guidelines to consider the benefits of AID for people with type 1 diabetes during fasting.
- Older participants with higher education, and employment demonstrated higher odds for successful fasting.
- AID systems are highly effective and safe for managing diabetes during Ramadan fasting, outperforming other treatment methods.
- The study supports the superiority of AID technology and suggests updating guidelines to consider the benefits of AID for people with type 1 diabetes during fasting.
Summary Snap
Shots
AID technology allows PWT1D to safely fast during Ramadan with better blood sugar control. The study suggests updating current guidelines to reflect the lower risks for AID users during fasting. AID users achieved the highest Time in Range (TIR) and lowest Time Below Range (TBR), Time Above Range (TAR), and Glycemic Risk Index (GRI). No significant increase in diabetes complications for AID users during fasting.
Prime Insight
This study is noninterventional, the largest of its kind, looking at the safety and effectiveness of Automated insulin delivery with CGM use during Ramadan, April 2-May 2, 2022.
Participants were recruited from five medical centers in Riyadh and Madinah, Saudi Arabia. It was noted AID users had the best pre-Ramadan glycemic control among CGM users.
This groundbreaking study reveals that people with type 1 diabetes using Advanced Insulin Delivery (AID) systems can fast safely during Ramadan, maintaining excellent blood sugar control and experience fewer complications compared to traditional diabetes treatments.
It was concluded people with type 1 diabetes using AID technology can fast safely during Ramadan.
The study included 294 participants, divided into five treatment groups:
- AID users (62 participants)
- Conventional pump with CGM (37 participants)
- Pump with self-monitoring of blood glucose (8 participants)
- Multiple daily injections with CGM (155 participants)
- Finally, multiple daily injections with self-monitoring of blood glucose (32 participants).
Data was collected in 3 phases:
Phase 1: Two months before Ramadan, participants were informed about the study and provided consent.
Phase 2: At the end of Ramadan, participants completed an online survey about their personal and diabetes-related details.
Phase 3: After Ramadan, we retrieved CGM data from participants who shared their data through the cloud.
It is also the first study to compare outcomes between AID users and other diabetes treatment users during Ramadan.
The study found AID users broke their fast fewer days, thus were able to fast twice as many days compared to other groups. AID users had the best glycemic control during Ramadan, with highest TIR (73%) and lowest TAR (25%).
53% of AID users met the dual target of fasting most days and maintaining TIR ≥70%, compared to 3% of conventional pump users and 44% of MDI + CGM users.
Insulin doses for AID users slightly decreased during Ramadan. Acute diabetes complications and ER visits were low across all groups, with no significant differences. It can be inferred the effectiveness of AID is attributed to its ability to automatically adjust insulin levels based on blood sugar readings helping users manage the lifestyle changes during Ramadan.
Disparities in access to AID technology, often limited to those with higher socioeconomic status, need to be addressed to improve outcomes for all PWT1D.
It was concluded people with type 1 diabetes using AID technology can fast safely during Ramadan. They maintained good blood sugar control without increased risks of complications. The study shows AID is better than other treatments for managing diabetes during fasting. Current guidelines should be updated to reflect this, giving lower risk scores to those using AID with continued education.
- A Deeper Dive
- The Sources Voice
“Despite the challenges and presumed risks that PWT1D face as they attempt to fast during Ramadan, PWT1D who use AID technology can successfully fast most days of Ramadan while maintaining their glycemic control within the target range.”
- Curiosities Clarified
AID systems are more effective than other diabetes treatments in managing blood glucose levels during Ramadan fasting, providing better glycemic control and reducing the risks of hypoglycemia and hyperglycemia.
AID users have better Time in Range (TIR), lower Time Below Range (TBR) and Time Above Range (TAR), and a lower Glycemic Risk Index (GRI) compared to those using other diabetes treatments during Ramadan.
Education on insulin and diet management is recommended when using AID systems during Ramadan to achieve better glycemic control and reduce the risks of hypoglycemia and hyperglycemia, ensuring safer fasting for people with type 1 diabetes.