Telemedicine allows safe Ramadan fasting for young T1D patients despite COVID-19 lockdown

Despite clinic restrictions due to the novel coronavirus disease (COVID-19) pandemic, telemedicine enables young type 1 diabetes (T1D) patients on insulin pumps to safely fast in observance of Ramadan, reports a new Bangladesh study.

In a small cohort of nine patients (mean age, 19.3±5.0 years; 55.6 percent female) who expressed their desire to fast during Ramadan, six participants fasted for more than 20 days. By the seventh day of fasting, three patients had achieved adequate control of fasting glucose levels.

By the second week of fasting, basal dose had to be increased in two patients due to a spike in the fasting level, reaching >10 mmol/L. Four patients maintained their insulin dose throughout the month of Ramadan, seeing only minor changes. By the end of the fasting period, two other participants needed dose adjustments during their evening meals.

One patient experienced hyperglycaemia during the daytime and needed basal dose adjustments. The same patient had to break the fast due to another episode of hyperglycaemia in the afternoon, with blood glucose levels exceeding 20 mmol/L. Another patient experienced hyperglycaemia, but dose adjustments were enough to remedy this, and there was no need to break the fast.

Three patients experienced hypoglycaemia, all in the morning and mid-afternoon, and as per the healthcare providers’ instructions, they needed to break the fast. There were no episodes of severe hypoglycaemia, and no patient had to be hospitalized.

In the present study, all patients and their caregivers were given instructions by the diabetes team through telemedical platforms and were told to report back in using the same platform in cases of hyper- or hypoglycaemia.

“Fasting during Ramadan is feasible in patients with T1D using an insulin pump, with adequate counselling and support,” the researchers said. “During COVID-19 crisis in Bangladesh, patients with T1D on insulin pump could fast in Ramadan with support of telemedicine service by diabetes team.”