Safety of Fasting in Patients with Type 1 Diabetes during Ramadan: A Prospective Study from Pakistan

Aims: To observe safety of fasting in patients with type 1 diabetes during Ramadan. Methods: A prospective, case control study was conducted in the Out-patient department of Baqai Institute of Diabetology and Endocrinology from June to September 2013. The study was carried out in two phases; Pre-Ramadan recruitment phase (Visit A) and Post-Ramadan follow-up phase (Visit B) of the same patients. In visit A, Ramadan-specific diabetes education was delivered by health care providers in group session and educational material provided to each patient. Results: Sixty two patients with type 1 diabetes (42 in fasting and 20 in non-fasting group) participated in the study. No significant change (p > 0.05) observed in weight and HbA1c of fasting and non-fasting groups before and after Ramadan. During Ramadan, out of 1380 blood glucose readings in fasting group, there were 98 (7.1%) and 570 (41.3%) episodes of hypoglycemia and hyperglycemia respectively. None of the patients developed diabetic ketoacidosis and none required hospitalization. No significant difference (p > 0.05) observed in the frequency of hypoglycemia while hyperglycemia increased (p < 0.05) when glycemic status during Ramadan was compared with Pre-Ramadan. No significant difference (p > 0.05) observed in the frequency of hypoglycemia and hyperglycemia when Ramadan was compared with Post-Ramadan. Conclusion: We observed that majority of patients with type 1 diabetes did not have serious acute complications of diabetes during Ramadan. Safety of fasting can be ensured in patients with type 1 diabetes with Ramadan-specific diabetes education and medical supervision.