Abstract
IDF-DaR guidelines recommend late Suhoor (pre-dawn meal) , this does not give much time for correction and can lead to breaking the fast in the early hours. Objective: To estimate Hypoglycemia risk in T1D fasting Ramadan when eating Suhoor 90-120 minutes before dawn versus 30 minutes before dawn. Methods: Prospective randomized cross-over design. T1D insisting to fast recruited. Data collected using pre/post-Ramadan questionnaires, and FCGM - Freestyle Libre. Results: 44 T1D patients randomized to early vs. late Suhoor regimens for a week then crossed to the other regimen the second week. 42 MDI and 2 CSII. Mean age 25 ±5.9 years (range 15-39) , DM duration 13.7 ±6.6 years, 73.5% female. Pre-Ramadan A1c ≤7 30.2%, and >9 20.9%. (22.7%) reported frequent hypoglycemia (≥3/week) , and 4 (9.1%) reported hypoglycemia unawareness. During the early vs. late regimen self-reported hypoglycemia leading to breaking of fast 64.5% vs. 58.1%, p=0.18; occurring most commonly in: Morning (38.5%) vs. 14 (60.9%) , and noon 11 (42.3%) vs. 5 (21.7%) p=0.09. Mean days fast broken 2.5±1.6 vs. 2.05±1.4, p=0.7. One severe hypoglycemia, and one admission reported with the late regimen. No DKA admission during either regimen. FCGM detected mean hypoglycemia events per patient per week of early vs. late regimen was 5.5 vs. 5.4, p=0.65; for post Suhoor (6 -11am) 0.94 vs. 1.07, p=0.25. Overall hypoglycemic events were significantly higher during morning/noon compared to pre-sunset 1.9 vs. 0.43, p<0.001. AGP report: GMI 7.58 ±1.vs. 7.49 ±0.9, p=0.36, Time in range (70-180 mg/dl) 46.9 ±17.3% vs. 47.9 ±17.3%, p=0.99, Time below range (<70mg/dl) 8.6 ±14.3% vs. 7.8±7.6%, p=0.15, Time above range (>180mg/dl) 45.8 ±22.03% vs. 44.5 ±20.1%, p=0.6, and Glucose variability 39.3 ±10.5% vs. 40.6 ±6.5%, p=0.005. Conclusion: Managing T1D who fast Ramadan is challenging. Adjusting Suhoor meal and insulin dose time to allow post meal correction provides flexibility. Larger studies needed to demonstrate effectiveness of this approach.