Alguwaihes Abdullah M, Alyusuf Ebtihal Y, Alrajeh Areej, Alotaibi Metib, Al-Sofiani Mohammed E
Division of Endocrinology, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Dallah Hospital, Diabetes Center, Riyadh, Saudi Arabia.
Front Endocrinol (Lausanne). 2025 May 29;16:1399990. doi: 10.3389/fendo.2025.1399990. eCollection 2025.
Adults with type 1 diabetes (T1D) who fast during Ramadan remain a severely understudied population in terms of changes in glycemic control, making evidence-based recommendations for insulin adjustments difficult in this age-group. To fill this gap, we aimed to prospectively observe the changes in glycemic control of young adults with T1D who fast during Ramadan.
In this 3-year prospective study, we enrolled participants with T1D with flash glucose monitoring (FGM) data during the Ramadan periods of 2020-2022. CGM data for 4 weeks before, during, and after Ramadan were collected and analyzed. A sub-cohort of age-matched non-DM participants (N=49) who fasted during the Ramadan of 2022 were included for comparison.
A total of 76 participants were enrolled, of whom only 39 (19 males and 20 females, mean age 28.1 ± 8.4 years) completed the three-year follow-up. The mean duration of diabetes among these participants was 11.5 ± 8.9 years. Ten (26%) patients were on insulin pump, and 22 (56%) patients received Ramadan-focused education at baseline. Pooled glycemic trends during Ramadan showed two main abnormal glucose spikes: after Iftar (between 16:00-18:00 and 18:00-20:00), with a difference of 15.5mg/dL, and after Suhoor (between 0:00-2:00h to 4:00-6:00), with a difference of 18.8mg/dL. These abnormal glycemic indices persisted a month after Ramadan. In parallel, these glucose spikes were also observed in non-DM participants, but remained within normal limits.
Ramadan fasting among adults with T1D in SA is associated with deterioration in glycemic control, with the highest glucose spikes observed after Iftar and Suhoor. These hyperglycemic episodes were most prominent during Ramadan and persisted for at least a month after. The present real-time evidence warrants the need to review insulin adjustments in this understudied group, focusing on high risk patients with T1D, including those with history of overindulgent behavior during Ramadan.
在斋月期间禁食的1型糖尿病（T1D）成年患者，在血糖控制变化方面仍是一个研究严重不足的群体，这使得针对该年龄组的胰岛素调整难以提出循证建议。为填补这一空白，我们旨在前瞻性观察斋月期间禁食的T1D青年成人的血糖控制变化。
在这项为期3年的前瞻性研究中，我们纳入了在2020 - 2022年斋月期间有闪光葡萄糖监测（FGM）数据的T1D参与者。收集并分析了斋月前、期间和之后4周的连续血糖监测（CGM）数据。纳入了一个年龄匹配的非糖尿病参与者亚组（N = 49），他们在2022年斋月期间禁食，用于比较。
共纳入76名参与者，其中只有39名（19名男性和20名女性，平均年龄28.1±8.4岁）完成了三年随访。这些参与者的糖尿病平均病程为11.5±8.9年。10名（26%）患者使用胰岛素泵，22名（56%）患者在基线时接受了针对斋月的教育。斋月期间的综合血糖趋势显示出两个主要的异常血糖峰值：开斋饭后（16:00 - 18:00和18:00 - 20:00之间），差值为15.5mg/dL，以及封斋饭后（0:00 - 2:00至4:00 - 6:00之间），差值为18.8mg/dL。这些异常血糖指标在斋月后持续了一个月。同时，在非糖尿病参与者中也观察到了这些血糖峰值，但仍在正常范围内。
沙特阿拉伯T1D成年患者在斋月期间禁食与血糖控制恶化有关，开斋饭和封斋饭后观察到最高的血糖峰值。这些高血糖发作在斋月期间最为突出，并在之后至少持续一个月。目前的实时证据表明有必要重新审视这个研究不足群体的胰岛素调整，重点关注T1D高危患者，包括那些在斋月期间有过度放纵行为史的患者。
