Department of Endocrinology, University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Tunis, Tunisia.
Department of Endocrinology, University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Tunis, Tunisia.
Nutrition. 2018 Jan;45:99-103. doi: 10.1016/j.nut.2017.07.014. Epub 2017 Aug 3.
The risk for hypoglycemia during Ramadan fasting in patients with adrenal insufficiency (AI) is not fully known. The aims of this study were to evaluate this risk objectively and to determine the associated factors.
This prospective case-crossover study included 25 women and 5 men with known and treated AI and a median age of 38.5 y. Patients underwent clinical examination and a fasting blood sample was collected to measure glucose, urea, creatinine, sodium, potassium, cortisol, growth hormone and free thyroxine. A 24-h continuous glucose monitoring system (CGMS) using iPro2 (Medtronic, Parsippany, NJ, USA) with Enlite sensor (Medtronic) was performed for each patient during a Ramadan fasting day then again during a nonfasting day.
Interstitial glucose levels during the 24-h period, the fasting period, and the fasting period after exclusion of the 5 postprandial hours were significantly lower during the fasting day than on the nonfasting day. Hypoglycemia occurred in three patients (10%) during the fasting day but not during the nonfasting day (P = 0.23). Hypoglycemia was asymptomatic in two cases. Male sex was significantly associated with the occurrence of hypoglycemia.
Interstitial glucose levels were lower during fasting in patients with AI. However, the risk for hypoglycemia was not increased.
在肾上腺功能不全（AI）患者的斋月禁食期间发生低血糖的风险尚不完全清楚。本研究的目的是客观评估这种风险，并确定相关因素。
这项前瞻性病例交叉研究纳入了 25 名女性和 5 名男性，他们患有已知且经过治疗的 AI，中位年龄为 38.5 岁。患者接受了临床检查，并采集空腹血样以测量血糖、尿素、肌酐、钠、钾、皮质醇、生长激素和游离甲状腺素。每位患者在斋月禁食日和非禁食日进行一次 24 小时连续血糖监测系统（CGMS）检查，使用 iPro2（美敦力，新泽西州帕西帕尼）和 Enlite 传感器（美敦力）。
在 24 小时期间、禁食期间以及排除 5 小时餐后时间后的禁食期间，患者的间质葡萄糖水平在禁食日显著低于非禁食日。在禁食日有 3 名患者（10%）发生了低血糖，但在非禁食日没有发生（P=0.23）。有两例低血糖无症状。男性与低血糖的发生显著相关。
AI 患者在禁食期间间质葡萄糖水平较低，但低血糖的风险并未增加。
