Fasting in Ramadan during the Peak of COVID-Pandemic: DAFNE Graduates Experience

ABSTRACT

Background: The lockdown due to the COVID-pandemic in April 2020 led to the suspension of face-to-face diabetes care and education. In this period, management of diabetes emergency was a challenge because it needed rapid recognition, diagnosis and treatment. Despite adverse situations, many DAFNE graduates had chosen to fast during Ramadan. This was supported virtually to DAFNE graduates through intermittently scanned continuous glucose monitoring (isCGM) . Aims: This study aimed to compare the isCGM glucose metrics of people with T1D who fasted during Ramadan. Methods: Baseline and fasting period isCGM data were collected. The primary outcome measures HbA1c, time in range [ (TIR) 3.9- mmol/L], time below range [ (TBR) <3.9 mmol/L], coefficient of variation (CV) , and self-reported adverse events. Results: A total of 35 people with T1D fasted with a median of 20 days. Mean HbA1c was 7.5 (0.93) % and 7.4 (0.91) % before and after fasting periods, respectively. No significant change in TIR (pre 61.1 ± 17.9% vs. during 61.9 ± 14.9%) and TAR (pre 32.1 ± 19.0% vs. during 33.1 ± 15.6%) were found. However, TBR (pre 6.8 ± 5.4% vs. during 5.0 ± 4.6%) was significantly decreased (p= 0.045) . The CV (-2.3%) and low glucose events (-5.0) also decreased during the fasting period (p≤ 0.010) . No episodes of severe hypoglycemia, DKA, or hospitalization occurred during the fasting period. Conclusions: DAFNE graduates can fast safely without the fear of hypoglycemia, and safe metrics of glycemia using diabetes self-management skills, including disaster situations like the COVID-pandemic.