title: Safety and metabolic impact of Ramadan fasting in children and adolescents with type 1 diabetes.
abstract: BACKGROUND
  Annually, many children and adolescents with type 1 diabetes mellitus (T1DM) insist on fasting for Ramadan despite being exempted and despite knowing all the risks. We aimed to assess the safety and metabolic impact of Ramadan fasting in children with T1DM using different insulin regimens.
  
  
  METHODS
  Children with T1DM who choose to fast during Ramadan 1434/2013 (29 days) were recruited 3 months before Ramadan. They received pre-Ramadan intensive education. Three insulin regimens were included; Regimen-I (regular insulin/NPH); Regimen-II (regular insulin/insulin glargine) and Regimen-III (premixed insulin). Changes in weight, insulin dose, HbA1c, fructosamine and lipid profile were evaluated.
  
  
  RESULTS
  Out of total 53 patients (24 male), 28 patients (52.8%) completed Ramadan fasting (fasting group). The remaining 25 patients were included in (broke-fasting group). Positive correlation between fructosamine changes and number of days fasted during Ramadan. Significant decrease in post-Ramadan fructosamine (<0.001) and increase in post-Ramadan total cholesterol and low density lipoprotein (LDL) levels were detected within fasting, broke-fasting and insulin regimen groups. Significant higher blood glucose at three time points, pre-Iftar, pre-Sohur and midday in Regimen-I compared to Regimen-II and Regimen-III (p=0.004).
  
  
  CONCLUSIONS
  Fasting during Ramadan is feasible and is associated with significant improvement in fructosamine level in children with T1DM using different insulin regimens. Mandatory consideration to the quality and quantity of food offered to patients with T1DM during Ramadan to guard against adverse changes in lipid profile.
authors.forename: Amany
authors.initials: A
authors.lastname: El-Hawary
authors.forename: Nanees
authors.initials: N
authors.lastname: Salem
authors.forename: Ashraf
authors.initials: A
authors.lastname: Elsharkawy
authors.forename: Abdelhameed
authors.initials: A
authors.lastname: Metwali
authors.forename: Alaa
authors.initials: A
authors.lastname: Wafa
authors.forename: Nehad
authors.initials: N
authors.lastname: Chalaby
authors.forename: Abelhady
authors.initials: A
authors.lastname: El-Gilany
authors.forename: Megahed
authors.initials: M
authors.lastname: Abo-Elmagd
authors.forename: Magdy
authors.initials: M
authors.lastname: El-Ziny
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000378:metabolism*; D001786:Blood Glucose / Q000032:analysis; D001835:Body Weight; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000378:metabolism*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005215:Fasting / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D019270:Fructosamine / Q000097:blood; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007514:Islam; D008297:Male; D010353:Patient Education as Topic; D011379:Prognosis; D011446:Prospective Studies; D012449:Safety
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D019270:Fructosamine; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human