title: Attitude, complications, ability of fasting and glycemic control in fasting Ramadan by children and adolescents with type 1 diabetes mellitus.
abstract: OBJECTIVE
  Sick individuals and children are exempted from fasting Ramadan. Fasting by type 1 diabetes patients might predispose to acute complications. There are no guidelines on fasting safety or its impact on diabetes control in children and adolescents. We aim to assess patients' attitude towards fasting, frequency of complications and impact on glycemic control in children with type 1 diabetes.
  
  
  METHODS
  65 children with type 1 diabetes were enrolled. The study involved 2 hospital visits. Questionnaires were filled in each visit and HbA1c was recorded. Log books indicating symptomatic hypoglycemia and hyperglycemia leading to breaking fast were obtained.
  
  
  RESULTS
  Majority of subjects were willing to fast and 75% were encouraged by parents to do. 57% and 26% fasted more than half and all through the month respectively. 52% had, at least, one episode of hypoglycemia and 29% had hyperglycemia with one episode of ketoacidosis. All patients broke fast in response to symptomatic hypoglycemia/hyperglycemia. There was no significant difference between the frequency of complications in the pump or the Multiple Daily Injection (MDI) groups. Mean HbA1c increased from 70mmol/mol to 73mmol/mol. The difference was not statistically significant.
  
  
  CONCLUSIONS
  Children and adolescents with type 1 diabetes are keen to fast Ramadan and they are able to fast a significant number of days. Hypoglycemia and hyperglycemia are not uncommon with no difference between Pump or in MDI users. Breaking fast on occurrence of complications makes fasting safe. Glycemic control might deteriorate during the month and the following Eid.
authors.affiliation: Paediatric Endocrinology Department, Mafraq Hospital, AbuDhabi, United Arab Emirates. Electronic address: adeeb@seha.ae.
authors.forename: Asma
authors.initials: A
authors.lastname: Deeb
authors.affiliation: Paediatric Endocrinology Department, Mafraq Hospital, AbuDhabi, United Arab Emirates.
authors.forename: Nabras
authors.initials: N
authors.lastname: Al Qahtani
authors.affiliation: Paediatric Endocrinology Department, Mafraq Hospital, AbuDhabi, United Arab Emirates.
authors.forename: Mariette
authors.initials: M
authors.lastname: Akle
authors.affiliation: Medical School, Gulf University, Ajman, United Arab Emirates.
authors.forename: Himanshi
authors.initials: H
authors.lastname: Singh
authors.affiliation: Medical School, Gulf University, Ajman, United Arab Emirates.
authors.forename: Rifah
authors.initials: R
authors.lastname: Assadi
authors.affiliation: Paediatric Endocrinology Department, Mafraq Hospital, AbuDhabi, United Arab Emirates.
authors.forename: Salima
authors.initials: S
authors.lastname: Attia
authors.affiliation: Paediatric Endocrinology Department, Mafraq Hospital, AbuDhabi, United Arab Emirates.
authors.forename: Hana
authors.initials: H
authors.lastname: Al Suwaidi
authors.affiliation: Paediatric Endocrinology Department, Mafraq Hospital, AbuDhabi, United Arab Emirates.
authors.forename: Tara
authors.initials: T
authors.lastname: Hussain
authors.affiliation: Institute of Public Health, Emirates University, Al Ain, United Arab Emirates.
authors.forename: Nico
authors.initials: N
authors.lastname: Naglekerke
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy; D005215:Fasting / Q000097:blood / Q000502:physiology*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy / Q000453:epidemiology; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007514:Islam; D007662:Ketosis / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents
keywords: Children; Fasting; Hyperglycemia; Hypoglycemia; Ramadan; Type 1 diabetes