Endocrine Abstracts

Introduction: Many Muslim patients with diabetes observe dawn to dusk fasting during the month of Ramadan. In an observational prospective study, we have used continuous glucose monitoring system (CGMS) to investigate the changes in glucose profiles amongst Muslim patients during Ramadan fasting.

Methods: CGMS was applied to patients with type 2 diabetes mellitus (n=14) attending AlZahra Hospital Sharjah for three consecutive days, before (non-fasting) and then during Ramadan (fasting). Necessary changes to timing and dosing of medication were made. Two CGMS curves were constructed by pooling complete individual 24 h glucose datasets in fasting and non-fasting periods. For each period, area under the curve (AUC), low blood glucose index (LBGI) and high blood glucose index (HBGI) were calculated using methods previously described. For non-diabetic subjects the same procedure and analyses were performed.

Results: Among the diabetic patients studied (3 female, 11 male, age 45.2±7.4 HbA1c 7.8±2.0%, BMI 30.9±4.1 kg/m²) and also amongst non-diabetic subjects (n=2), there were no significant differences in AUC for glucose curves during fasting (1389 mmol/l×5 min daytime, 1354 mmol/l×5 min night-time) and non-fasting (1346 mmol/l×5 min daytime, 1432 mmol/l×5 min night-time) periods. Mean glucose profile during fasting was characterized by a small peak in early morning (corresponding to pre-dawn meal), lower glucose for part of the day and a rapid rise in glucose level with a large peak in the evening (evening meal). LBGI in both fasting and non-fasting periods were below 4. HBGI was higher in the evening during Ramadan.

Conclusion: During Ramadan fasting, in the group studied there was a common problem with hyperglycaemia after the evening meal; hypoglycaemia occurred rarely. Major emphasis on dietary advice and a more appropriate adjustment in antidiabetic treatment could help in achieving better glycaemic control with Ramadan fasting.