IMPE Abstracts

Background: Guidelines for safe fasting strategies exist for both adolescents and adult patients living with type 1 diabetes (T1DM). Management of T1DM during fasting is complex, however, strategic approaches including insulin adjustments, education, and nutritional modifications to reduce the likelihood of hypoglycemia.

Aim: This prospective study assessed the safety and effectiveness of an advanced hybrid closed-loop (AHCL) system on glycemic metrics and the level of hypoglycemia in T1DM patients who wished to fast Ramadan.

Methods: Forty-eight T1DM patients (mean age 17.5 ± 4.6 years) using AHCL system were divided into two groups (each n=24): intervention group who adjusted AHCL settings and control group who kept the same settings as before Ramadan.

Results: The most aggressive system settings among control group consisting of a 100 mg/dL glucose target, active insulin time of 2 hours and bolus increment, maintained exceptional glycemia with time in range reaching 84.1 ± 8.6%, time above range >180 mg/dL of 11.5 ± 2.4% without an increase in hypoglycemia (time below range 2.9 ± 0.4%). All of which were non-significant in comparison to the intervention group. Overall time spent in closed loop (SmartGuard) by users averaged 98.5 ± 2.4% in Auto Mode and involved only 1.1 ± 0.6 exits per week indicating confidence in the system’s performance. No severe hypoglycemic or DKA events during study.

Conclusions: AHCL system assist in safe fasting with minimal user input and allows for achievement of recommended glycemic targets in people with T1DM during Ramadan fasting with reduction in hypoglycemia exposure without compromising safety.