Safety of Ramadan Fasting in Children, Adolescents and Young People withType 1 Diabetes Ramadan

Abstract

Fasting during Ramadan, one of the five pillars of Islam is an obligatory duty for all healthy Muslims from age
12 years. The Quran specifically exempts people with a medical condition from the duty of fasting, especially if
it might have harmful consequences. However, many people with diabetes insist on fasting during Ramadan and
there is high risk of developing acute complications; the major risk during Ramadan is hypoglycemia and excessive
consumption of sweet and fried foods with the sunset and pre-dawn meal may predispose to hypergly- cemia and
diabetic ketoacidosis.
This study aimed to determine safety of Ramadan fasting, change in HbA1c value& weight among children,
adolescents and young people with type 1 diabetes.
A prospective observational study was designed for children adolescents and young people with T1DM - at diabetic clinic in Tripoli Children Hospital- who wish and insist on fasting during Ramadan 1435 lunar year (July
2014).
Patients were revised 3 months before the start of Ramadan for education, they were on Basal- bolus regime either by using multiple daily injections (MDI) or flexible insulin regimen (FIR), Insulin dose was 0.7-1.5 u/kg/day
according to the requirement of the individual patient.
109 patients were involved (65.1%) were female; mean age was 15.0 years (±2.9) SD, mean duration for diabetes
was 6.4 yrs. (±4.0) SD. Mean weight before and after Ramadan is the same 61.4 (±13.9) P value 0.96. Mean
HbA1C pre Ramadan 8.9 (±1.7) compared with 8.6 (±1.6) after Ramadan P value 0.26. No significant difference in
occurrence of hypoglycemia, hyperglycemia and diabetic ketoacidosis (DKA) pre-Ramadan and during Ramadan.
We compared 45 patients (Group I) who complete their fast for whole month with 55 patients (Group II) who broke
their fast; (median of non-fasting days is 4 days). Mean HbA1C Group I mean 8.6(±1.7) pre Ramadan,
8.2 (± 1.5) post Ramadan while Group II mean 9.3 (±1.7) to 9.1 (±1.6), DKA was reported only in Group II
pre-Ramadan and during Ramadan. In group I hypoglycemic episodes occur in 29 patient pre Ramadan (28 mild
and 1 was severe) only 15 patients had mild hypoglycemic episodes during Ramadan P value was 0.003. In group
II hypoglycemic episodes occur in 23 patient pre Ramadan (22 mild and 1 severe); 34 patient had episodes of
hypoglycemia during Ramadan (29 mild and 5 severe) P value was 0.01, difference between 2 groups was
significance P value 0.001.Hyperglycemia in group I occur in 35 patients pre Ramadan, same number had hyper
glycaemia during Ramadan; in group II episodes occur in 34 patients pre Ramadan which increase to 43 episodes
during Ramadan, the difference between 2 groups in occurrence of hyperglycemia during Ramadan was significance
P value 0.05.
Conclusion: Children and adolescents older than 12 years and young people with type one diabetes on basal bolus
regimen can fast safely during Ramadan provided they have proper education and more glycemic control before
Ramadan.