RESUMO
Introduction: Fasting in Ramadan poses a risk for children with type 1 diabetes (T1D) who insist on fasting. This project was caried out during Ramadan 2021 for older children and adolescents with T1D to ensure safe fasting during the COVID -19 pandemic Objectives: Using the social media platform to ensure safe fasting during Ramadan among children and adolescents with T1D. Methods: A total of23 older children and adolescents (mean age was14.4 ± 2.95) who chose to fast during Ramadan2021 were successfully close-monitored. Among 11(52.17%) of them, insulin was administered by MDI and12(47.8%)were on IPT. Prior to starting this project, a pre-Ramadan education webinar was conducted to educate children and their family members on how to fast safely in Ramadan. The webinar was focused on the following: fasting eligibility, dose adjustment, carbohydrate counting, hypoglycemia and hyperglycemia management and glucose monitoring timing. Due to COVID-19 pandemic, the progress of the participants was tracked via a welldeveloped daily online questionnaire shared via WhatsApp to adjust the insulin doses when required. All these instructions were given to the patients in the presence of their guardians. Results: Of the total fasting days (30 days), the children were able to fast 14.57± 5.59 days, whereas 15.43±5.72 of these days were not fasted. The most common cause of breaking the fast was mild hypoglycemia events (9.2%, of all cases), followed by hyperglycemia (23.08% before Iftar) for both groups. No events of severe hypoglycemia, DKA, or hospitalization occurred. Furthermore, there was no significant difference in the average of blood glucose levels between two groups (Table 1). Conclusions: Despite the COVID-19 situation, the pediatric team managed to use the social media to deliver pre-education webinar and provided daily supervision to participants who fasted Ramadan, with the main aim of preventing severe hypoglycemia and hospitalization. (Table Presented).
RESUMO
Introduction: Kids In Control Of Food (KICk OFF) has been conducted in Kuwait since 2015. The Kuwait team adapted and modified the course to a 3-day format instead of a 5- day, due to the attendees preferences. Objectives: To pilot a modified educational program KICk-OFF for children and adolescents (11-16 years old) with T1D and to evaluate the HbA1C and weight change, when compared with usual care Methods: The team successfully conducted 4 modified courses from July- September 2019 at Damsan diabetes institute (DDI). Prior to the trial courses that were conducted;the team responded to the requests of the previous graduates by piloting a shorter format (3-day). Also, the following modifications were made: 1)Ongoing follow up individual sessions, 2) Group booster sessions 4 weeks post course,3) Sending biweekly text messages, 4) Fasting Ramadan sessions and 5) Flash glucose monitoring devices were distributed throughout the courses instead of the classical SMBG. Glycaemic control measured by HbA1c and body weight calculated by body mass index (BMI) were taken at baseline, 6, and 12 months for intervention groups and compared with controls. Results: Due to the Covid-19 pandemic, the trail outcomes were tracked up to 6months instead of 12months. For the intervention group, there was a significant reduction in mean HbA1c (n =22, pre: 9.6 ± 2.0%vs. post 8.6 ± 0.9%;P = 0.01), whereas, there was no significant BMI differences (n=22, pre 23.52±4.6 vs. post-I 23.74±4.2;P =0.8). Moreover, no episodes of severe hypoglycemia, DKA, or hospitalization occurred after 6 months for all graduates. In addition, three graduates started insulin pump therapy. Finally, there were no changes in HbA1c (n=21, pre: 9.6 ±1.9% vs. post 9.2 ±1.2%;P= 0.19) and BMI (n=21 pre22.7 ±5.6 vs. post23.1 ±5.9, P=0.37) in the control group. Conclusions: Joining a 3-day KICk-OFF Kuwait format was associated with significantly improved in Glycaemic control at 6 months compared with control group. These outcomes need to be confirmed in a study with a longer duration.