Evaluation of optimum diabetes care on glycemic control of patients with gestational diabetes during Ramadan fasting.

Aims: There is limited evidence that evaluates the impact of fasting during Ramadan in pregnant women. We explored the safety of fasting in Gestational Diabetes Mellitus (GDM) in Ramadan, while understating the glycemic variability.

Methods: 25 patients with GDM who choose to fast, were enrolled and provided optimum care that included Ramadan focused education and FreeStyle LibreFlashContinuous Glucose Monitoring(FSL-CGM) was utilized for 2-4 weeks assessment period of non-Ramadan days plus 2-3 weeks during Ramadan and medication adjustment.

Results: The average glucose improved significantly, while time in target and percent above target numerically improved during Ramadan compared to pre-Ramadan. There was significant increment on the number of hypoglycemic events in Ramadan. The average lowest blood glucose reading reduced significantly by 14 mg/dL with average duration of hypoglycemic events increased significantly by 38.5 min.

Conclusion: Our study reinforces the importance of structured education before Ramadan to deliver optimal care for the management of diabetes. Strikingly FSL-CGM demonstrated that hypoglycemia is significantly increased during Ramadan Fasting. There was effective reflection of hyperglycemic spikes, immediately post Iftar. The results corroborated with the earlier studies for higher frequency of hypoglycemia during Ramadan fasting, under similar standards of care in high-risk patients with diabetes.