Introduction and Objective: Most people with type 1 diabetes (PWT1D) are advised to not fast during Ramadan because of dysglycemia risks. We compared efficacy, safety profiles, and fear of hypoglycemia (FH) during Ramadan fasting in users of 4 insulin delivery modalities.Methods: Four treatment groups were compared: automated insulin delivery (AID) (n=114), sensor augmented pump (SAP) with predictive-low-glucose suspend (PLGS) (n=4), sensor-unintegrated pump (SUP) (n=24), and multiple daily injections (MDI)+continuous glucose monitoring (CGM) (n=136).Results: Pre/during-Ramadan percent time in range (TIR) for the AID, SAP-PLGS, SUP, and MDI-CGM groups was 73.2/73.4, 62/65.5, 57.8/54.6, and 52.1/47.4. The Pre/during Ramadan Glycemia Risk Index (GRI) for the AID, SAP-PLGS, SUP, and MDI-CGM groups was 30/29, 43/35, 52/55, and 60/64. The proportion of PWT1D achieving a “double target of fasting” (fasting was broken ≤2 days because of diabetes and TIR was >70%) for the AID, SAP-PLGS, SUP, and MDI-CGM groups was 46.5%, 25%, 12.5%, and 7.35%. AID system users were 22 times as likely to achieve the double target compared to MDI+CGM users after adjusting for age, gender, employment/insurance status, educational level, and diabetes duration. While the overall FH score did not significantly differ across the four groups (overall p>0.05), AID users had the lowest score and MDI had the highest score on the behavior subscale of the FH survey.Conclusion: Use of AID during Ramadan fasting was associated with fasting the most days of Ramadan, best glycemic control, and the least frequent hypoglycemia avoidance behaviors. The International Diabetes Federation/Diabetes and Ramadan International Alliance risk calculator should assign a lower risk score for AID technology when used by PWT1D
M. Al-Sofiani: Advisory Panel; Medtronic. Speaker’s Bureau; Insulet Corporation, Abbott, Lilly Diabetes. Advisory Panel; Dexcom, Inc., Roche Diabetes Care. Speaker’s Bureau; Sanofi. Research Support; Medtronic. Speaker’s Bureau; Vitalaire. S. Alharthi: None. M. Alsuhaibani: None. A.M. Alhashem: None. A.M. Almurashi: None. T.H. Almigbal: None. R. Alamoudi: None. H.A. Zarif: Other Relationship; Abbott, Medtronic. N. Alzaman: None. M. Almehthel: Advisory Panel; Novo Nordisk. Speaker’s Bureau; Novo Nordisk. Research Support; Novo Nordisk. Advisory Panel; Sanofi. Speaker’s Bureau; Sanofi. Research Support; Sanofi. Speaker’s Bureau; Lilly Diabetes. Advisory Panel; Abbott. Speaker’s Bureau; Abbott. Advisory Panel; Dexcom, Inc. Speaker’s Bureau; Bayer Pharmaceuticals, Inc. D.C. Klonoff: Consultant; Synchneuro, Thirdwayv, Tingo, Afon, embecta, Glucotrack, Lifecare, Novo Nordisk, Samsung.
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