Endocrine Abstracts

Introduction: During the month of Ramadan, healthy Muslims are required to fast from dawn until sunset. Whilst the Quran states that those who are chronically unwell and children are exempt, many individuals with diabetes choose to fast. The duration of fasting may be over 12 hours increasing the risk of diabetes related complications such as hypoglycaemia. We present data of children and young people (CYP) with Type 1 Diabetes Mellitus (T1DM) who fasted during Ramadan at a single paediatric diabetes centre in London. Prior to Ramadan all patients were given education in the form of an information leaflet and individual support if they expressed a desire to fast. The patients had access to the diabetes team 24 hours a day. Our aim was to evaluate safety and glycaemic control through reviewing time in range (TIR) and hypo/hyperglycaemic episodes from retrospective data before and during Ramadan.

Results: Fourteen CYP chose to fast. The mean age of patients was 15 years. Eight were males. The average duration since T1DM diagnosis was 6 years. All were using insulin pumps, one had a pump holiday during part of the fast. Prior to fasting seven patients could be considered high risk due to regular or severe hypo/hyperglycaemic episodes. Most patients recorded similar carbohydrate consumption during Ramadan to before fasting. There was no significant difference in TIR, frequency of hypo/hyperglycaemia or HbA1c. Five patients experienced hypoglycaemic episodes, however only one had significantly more episodes compared to the month prior, and as a consequence of fasting. This was addressed with support from the team. There were no hospital admissions, diabetic ketoacidosis or serious incidents. Only two patients called the diabetes team with specific queries due to fasting.

Conclusion: This evaluation highlights that with appropriate support it can be safe for CYP to fast for Ramadan and it is not associated with a short-term glycaemic deterioration. It is important to ask patients directly about lifestyle and religious choices to inform management. All patients who wish to fast should receive appropriate risk assessment and structured education to ensure they do so safely. There is a need for guidance for CYP and clinical trials to provide evidence-based support.