A real-world prospective study of the effectiveness and safety of automated insulin delivery compared with other modalities of type 1 diabetes treatment during Ramadan intermittent fasting

Objective: To compare the fasting experience and glycemic control during Ramadan among people with type 1 diabetes (PWT1D) who use automated insulin delivery (AID) versus other modalities of treatment. Research Design and Methods: A total of 294 PWT1D who attempted fasting during Ramadan 2022 were categorized based on treatment modality into: 1) AID (n=62); 2) Conventional pump + CGM (n=37); 3) Pump + self-monitoring of blood glucose (SMBG)(n=8); 4) Multiple daily injections (MDI) + CGM (n=155); and 5) MDI + SMBG (n=32). Predictors of fasting most days of Ramadan (i.e. breaking fast because of diabetes ≤2 days) were analyzed using uni- and multi-variable logistic regression. Results: The median numbers of days when fasting was broken because of diabetes were: 2, 5, 3, 3.5, and 2.5 for AID, conventional pump + CGM, MDI + CGM, pump + SMBG, and MDI + SMBG users, respectively(p=0.047). Users of AID had a significantly greater TIR; and lower glycemia risk index, TBR, and TAR compared to users of conventional pumps and MDI(both p<0.05). Likewise, 53% of AID users attained the “double target” of a)breaking fast because of diabetes ≤2 days and b)maintaining TIR≥70% during Ramadan compared to only 3% of the conventional pump users and 44% of the MDI + CGM users (both p<0.05). Compared to MDI + CGM users, AID users were twice as likely to complete fasting most days of Ramadan. Conclusion: Use of AID is associated with the highest rates of fasting and best glycemic control during Ramadan fasting.