Evaluation of Glycemic Control in Patients With Diabetes by a Continuous Glucose Monitoring System During the Month of Ramadan.

INTRODUCTION

Ramadan presents challenges for patients with type 2 diabetes mellitus (T2DM) who choose to fast. Maintaining good glycemic control through regular monitoring during fasting is crucial. This study aims to evaluate and compare glycemic fluctuations in fasting and non-fasting T2DM patients during Ramadan.

MATERIALS AND METHODS

We conducted a prospective comparative study on 39 T2DM patients, divided into fasting and non-fasting groups based on the International Diabetes Federation - Diabetes and Ramadan Alliance (IDF-DAR) Practical Guidelines 2021. Each patient wore an iPro®2 Continuous Glucose Monitoring System (CGMS) device (Medtronic plc, Dublin, Ireland), for five to seven days, with consultations scheduled before, during, and after Ramadan. Glycated hemoglobin (HbA1c) levels were measured before and after Ramadan. The fasting risk score was calculated using the DAR guidelines.

RESULTS

The fasting group included 29 fasting patients with an average fasting risk score of 2.7 according to the DAR guidelines, while the non-fasting group had 10 non-fasting patients with an average score of 6.55. The average HbA1c was estimated by the CGMS at 7.36% for fasting patients and 7.1% for non-fasting patients. In the fasting group, 80% of patients experienced at least one episode of hyperglycemia, averaging 4.03 episodes per day, predominantly occurring during pre-dawn (suhoor) and post-sunset (iftar) periods. Hypoglycemia occurred in 24% of fasting patients, mainly before iftar. In contrast, the non-fasting group had a higher average of 6.8 hyperglycemic episodes per day, with 50% of the group also experiencing hypoglycemia. Notably, a significant improvement in HbA1c was observed in the non-fasting group after Ramadan (7.77 ± 0.89 vs. 9.13 ± 1.99, p=0.037). No significant changes in HbA1c, weight, or body mass index were found in the fasting group.

CONCLUSION

Pre-Ramadan education, risk stratification, and continuous monitoring during Ramadan are essential to prevent metabolic complications in T2DM patients, whether fasting or non-fasting. CGMSs reveal a high prevalence of hyperglycemia, especially in non-fasting patients, underscoring the need for tailored treatment adjustments to achieve optimal glycemic control.