Predictors of Successful Fasting and Attaining Glycemic Targets during the Month of Ramadan among People with Type 1 Diabetes

Introduction: Muslims abstain from eating and drinking from dawn to dusk during Ramadan. We aim to evaluate the fasting experience of people with type 1 diabetes (PwT1D) and identify predictors of successful fasting and attaining glycemic targets during Ramadan. Methods: We included the 149 PwT1D who attempted to fast during Ramadan 2022, were seen in our Endocrine clinics during the month preceding Ramadan, and were using a continuous glucose monitor (CGM). They were categorized, based on their treatment modality, into 3 groups: a) Hybrid closed loop (HCL) pump (n=39); b) Open loop pump (n=12); and c) Multiple daily injections (MDI) (n=98). CGM Reports for Ramadan and the month preceding Ramadan and self-administered surveys about fasting experience were evaluated. Predictors for attaining the “double target” of: a) breaking fast ≤2 days and b) maintaining glucose time in range (TIR) ≥70% during Ramadan were analyzed using uni- and multi-variable logistic regression. Results: The “double target” of a) breaking fast ≤2 days and b) maintaining TIR≥70% during Ramadan was attained by 21.5% of PwT1D. Users of the HCL therapy, compared to the open loop and MDI users, had a significantly lower glycemia risk index (GRI), glucose management indicator (GMI), time below range (TBR), time above range (TAR), and average glucose during Ramadan (all p<0.05). Those with health insurance and better “pre-Ramadan” glycemic control (i.e. lower GRI, TAR, and coefficient of variation and higher TIR) were more likely to attain the “double target” during Ramadan. Users of the HCL pumps were more likely to attain the “double target” compared to the users of MDI + CGM [OR (95% CI): 25.47 (4.72, 137.49)] after adjusting for age, sex, educational level, employment status, insurance status, and diabetes duration. Conclusion: Using HCL pump therapy and having better pre-Ramadan CGM metrics predict attainment of the double target of fasting most of days and having TIR ≥70% during Ramadan among PwT1D. Disclosure 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.