title: Comparison of Insulin Pump Therapy and Multiple Daily Injections Insulin Regimen in Patients with Type 1 Diabetes During Ramadan Fasting.
abstract: Fasting Ramadan carries a high risk for patients with type 1 diabetes (T1DM). Data on the optimum insulin regimen in these patients are limited.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.affiliation: 1 Department of Medicine, Imam Abdulrahman Bin Faisal National Guard Hospital , Dammam, Saudi Arabia .
authors.forename: Reem
authors.initials: R
authors.lastname: Alamoudi
authors.affiliation: 2 Department of Medicine, King Abdulaziz National Guard Hospital , Alhasa, Saudi Arabia .
authors.forename: Maram
authors.initials: M
authors.lastname: Alsubaiee
authors.affiliation: 3 Department of Medicine, King Abdulaziz National Guard Hospital, King Abdullah International Medical Research Center , Alhasa, Saudi Arabia .
authors.forename: Ali
authors.initials: A
authors.lastname: Alqarni
authors.affiliation: 4 Department of Medicine, King Abdulaziz Medical City , Riyadh, Saudi Arabia .
authors.forename: Yousef
authors.initials: Y
authors.lastname: Saleh
authors.affiliation: 4 Department of Medicine, King Abdulaziz Medical City , Riyadh, Saudi Arabia .
authors.forename: Saleh
authors.initials: S
authors.lastname: Aljaser
authors.affiliation: 5 Biostatistics Unit, King Abdullah International Medical Research Center , Alhasa, Saudi Arabia .
authors.forename: Abdul
authors.initials: A
authors.lastname: Salam
authors.affiliation: 6 Department of Medicine, Hamad Medical Corporation , Doha, Qatar .
authors.forename: Mohsen
authors.initials: M
authors.lastname: Eledrisi
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005215:Fasting / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006693:Holidays; D006772:Hospitals, Military; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000139:chemically induced / Q000209:etiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000009:adverse effects; D007514:Islam; D008297:Male; D011446:Prospective Studies; D012529:Saudi Arabia; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Continuous glucose monitoring; Fasting; Insulin pump; Multiple daily injections; Ramadan; Type 1 diabetes