Introduction: Most people with type 1 diabetes (PwT1D) are considered high risk to fast during the month of Ramadan. Yet, many of them attempt to fast and abstain from eating and drinking from dawn to dusk. Here, we evaluate the association between the sociodemographic indicators, modality of T1D treatment, and number of days when fasting is broken due to diabetes among PwT1D.
Methods: We surveyed 294 PwT1D who attempted to fast during Ramadan 2022, were seen at our Endocrine clinics during the month preceding Ramadan, and who agreed to share their health information and fasting experience. Participants were categorized into 5 groups based on their treatment modality: a) Pump + CGM [Hybrid closed loop (HCL)] (n=62); b) Pump + CGM [Conventional open loop] (n=37); c) Pump + Self-monitoring of blood glucose (SMBG) (n=8); d) Multiple daily injections (MDI) + CGM (n=155); e) MDI + SMBG (n=32). Predictors for fasting most days of Ramadan (i.e. breaking fast≤2 days) were analyzed using uni- and multi-variable logistic regression.
Results: Private health insurance rates were highest among pump users (82%, 63%, and 41% for HCL, Pump + SMBG, and conventional open loop, respectively); whereas, MDI users had the lowest insurance rates (25% and 21% for MDI + SMBG and MDI + CGM, respectively). The median numbers of days when fasting was broken due to diabetes were 2, 5, 3, 3.5, and 2.5 days among the HCL, conventional open loop, MDI + CGM, Pump + SMBG, and MDI + SMBG groups, respectively (p=.047). Users of HCL therapy were two times as likely to complete fasting most days of Ramadan (i.e. breaking fast≤2 days) compared to MDI + CGM users [odds ratio (95% CI): 2.37 (1.14, 4.90)] after adjusting for age, sex, educational level, employment status, insurance status, and diabetes duration.
Conclusion: Among the common treatment modalities of T1D, the use of HCL pump therapy is associated with the highest rates of fasting most days of Ramadan after adjusting for potential confounders.
M.Al-sofiani: Consultant; Eli Lilly and Company, Speaker's Bureau; Sanofi, Medtronic, Vitalair. S.Alharthi: None. S.Albunyan: Employee; ProMedEx, Medtronic. N.Alzaman: None. D.C.Klonoff: Consultant; EOFlow Co., Ltd., Fractyl Health, Inc., Integrity, Lifecare, Inc., Rockley Photonics, Thirdwayv Inc. A.M.Alguwaihes: Consultant; Eli Lilly and Company, Research Support; AstraZeneca, Novo Nordisk, Speaker's Bureau; Novo Nordisk, Sanofi.
