Introduction and Objective: Intermittent fasting, including Ramadan fasting, increases the risk of hypoglycemia in people with type 1 diabetes (PWT1D). We examined the prevalence and predictors of fear of hypoglycemia (FOH) after Ramadan in PWT1D who attempted to fast.Methods: Fasting experience, glycemic control, and FOH were evaluated in 159 PWT1D who attempted to fast Ramadan 2024, used CGM for ≥2 weeks, and completed the Hypoglycemia Fear Survey (HFS-II) shortly after Ramadan. Participants were categorized by their scores on the HFS-Behavior (HFS-B) and HFS-Worry (HFS-W) subscales of the survey as follows: (High HFS-B: ≥1.85 vs Low HFS-B: <1.85) and (High HFS-W ≥0.92 vs Low HFS-W: <0.92).Results: Most participants (57%) reported high HFS-W and only 29% reported high HFS-B post-Ramadan. Ramadan CGM metrics were worse in those with high vs low HFS-B (TIR: 56.91% vs 63.98%; TAR>250: 16.57% vs 11.60%; TBR 54-70: 2.76% vs 1.86%; TBR<54: 0.67% vs 0.25%; and GRI: 53 vs 42, respectively, all p<0.05). Proportion of PWT1D achieving TBR target <4% was lower in the high vs low HFS-B groups (25.4% vs 74.6%, respectively, p=0.02). Among those with ≥1 severe hypoglycemia during Ramadan, 85.71% and 64.29% had high HFS-W and high HFS-B, respectively. Automated insulin delivery users had the lowest prevalence of high HFS-B (14.71%) vs other treatment modalities (allp<0.01). Severe hypoglycemia during Ramadan increased the likelihood of high HFS-B (OR: 4.54, 95% CI: 1.24, 16.68) and high HFS-W (OR: 5.42, 95% CI: 1.04, 28.40) after adjusting for age, gender, employment, educational level, insurance status, diabetes duration, TBR, and modality of treatment.Conclusion: Severe hypoglycemia during Ramadan is associated with increased FOH post-Ramadan in PWT1D. Our findings highlight the importance of empowering PWT1D who plan to fast Ramadan with the technology that they need to minimize risk of hypoglycemia during fasting and FOH afterward
S. Alharthi: None. M. Alsuhaibani: None. A.M. Almurashi: None. T.H. Almigbal: None. R. Alamoudi: None. H.A. Zarif: Other Relationship; Abbott, Medtronic. A.M. Alhashem: 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. N. Alzaman: None. R. Kalyani: None. 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.
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