Tawam Hospital in Affiliation with Johns Hopkins Medicine, P. O. Box 15258, Al Ain, United Arab Emirates.
J Endocrinol Invest. 2017 Jul;40(7):741-744. doi: 10.1007/s40618-017-0633-y. Epub 2017 Feb 26.
Even though patients with type 1 diabetes mellitus (T1DM) are exempted from fasting, the vast majority elect to fast against the advice of their healthcare providers. We have previously reported the incidence of wide fluctuations in blood glucose (BG) along with "unrecognized" severe hypoglycemia during Ramadan fasting in adolescents with T1DM. This report compares the continuous glucose monitoring (CGM) data during fasting in adolescents with T1DM according to their Pre-Ramadan diabetes control.
Children and adolescents with T1DM who intended to fast the month of Ramadan were asked to wear the CGM during fasting for a minimum of 3 days. Hypoglycemia, hyperglycemia, and severe hyperglycemia were identified as BG <70 mg/dL (3.9 mmol/L), BG 201-300 mg/dL (11.2-16.7 mmol/L), or BG >300 mg/dL (16.7 mmol/L) respectively, while normoglycemia was identified as BG 70-200 mg/dL (3.9-11.1 mmol/L). Patients were categorized as well-controlled (Group 1) and poorly controlled (Group 2) if the pre-fasting HbA1C was ≤8% (64 mmol/mol) and >8%, respectively. We compared the mean BG and the percentages of time spent in hypoglycemia, hyperglycemia, and severe hyperglycemia between the two groups using Chi-square (significant difference when P value was <0.05).
A total of 21 patients were enrolled (15 females), age 15 ± 4 years, duration of diabetes 6 ± 3 years, and HbA1C 8.5 ± 1.0% (70 mmol/mol). There were 7 subjects in Group 1, mean HbA1C 7.5 ± 0.4, and 14 subjects in Group 2, mean HbA1C 9.1 ± 0.9. The mean ± SD BG was 174 ± 76 mg/dL versus 199 ± 98, (P < 0.05) in Group 1 and Group 2, respectively. The percentages of hypoglycemia, hyperglycemia, and severe hyperglycemia were significantly higher in Group 2, while there was a higher percentage of normoglycemia in Group 1. The overall durations of hypoglycemia, hyperglycemia, and severe hyperglycemia in Group 2 were longer by 30, 14, and 135%, respectively, than those in Group 1.
Glycemic control before Ramadan in adolescents with T1 DM appears to correlate with blood glucose profile during Ramadan fasting. Our data suggest that optimal glycemic control before Ramadan may reduce the potential risks associated with fasting and minimize glucose fluctuation.
尽管 1 型糖尿病（T1DM）患者无需禁食，但绝大多数患者仍会违背医疗保健提供者的建议选择禁食。我们之前曾报道过，在青少年 T1DM 患者进行斋月禁食期间，他们的血糖会出现大幅波动，并伴有“未被识别”的严重低血糖。本报告比较了根据斋月前糖尿病控制情况，在青少年 T1DM 患者禁食期间的连续血糖监测（CGM）数据。
计划在斋月禁食的 T1DM 儿童和青少年被要求在禁食期间佩戴 CGM 至少 3 天。低血糖、高血糖和严重高血糖分别定义为血糖<70mg/dL（3.9mmol/L）、血糖 201-300mg/dL（11.2-16.7mmol/L）或血糖>300mg/dL（16.7mmol/L），而血糖正常定义为血糖 70-200mg/dL（3.9-11.1mmol/L）。如果患者的空腹糖化血红蛋白（HbA1C）≤8%（64mmol/mol），则将其归类为控制良好（第 1 组），如果 HbA1C>8%，则归类为控制不良（第 2 组）。我们使用卡方检验比较两组之间的平均血糖和低血糖、高血糖和严重高血糖所占时间的百分比（当 P 值<0.05 时差异有统计学意义）。
共有 21 名患者入组（15 名女性），年龄 15±4 岁，糖尿病病程 6±3 年，HbA1C 8.5±1.0%（70mmol/mol）。第 1 组有 7 名患者，平均 HbA1C 为 7.5±0.4，第 2 组有 14 名患者，平均 HbA1C 为 9.1±0.9。第 1 组和第 2 组的平均血糖分别为 174±76mg/dL 和 199±98mg/dL（P<0.05）。第 2 组的低血糖、高血糖和严重高血糖百分比明显高于第 1 组，而第 1 组的血糖正常百分比更高。第 2 组的低血糖、高血糖和严重高血糖持续时间分别比第 1 组长 30%、14%和 135%。
青少年 T1DM 患者斋月前的血糖控制情况似乎与斋月禁食期间的血糖谱相关。我们的数据表明，斋月前的最佳血糖控制可能会降低与禁食相关的潜在风险，并最大限度地减少血糖波动。
