Effectiveness of the low-glucose suspend feature of insulin pump during fasting during Ramadan in type 1 diabetes mellitus

Background Severe hypoglycaemia during the daytime of Ramadan fasting is a highly feared complication. In a prospective study, we investigated the effect of the low-glucose suspend (LGS) algorithm on the frequency of hypoglycaemia in adolescents with T1DM who wished to fast during Ramadan. Subjects and methods Sixty patients (19 males and 41 females, 15.6 +/- 2.7 years, duration of diabetes 5.8 +/- 2.9 years, pump therapy for 1.73 +/- 0.99 years, used the Paradigm((R)) Veo((TM)) System (Medtronic) and were divided into two groups: first (n=25), those who used the sensor with low-glucose suspend (LGS) feature and second (n=35), those who used the sensor but turned off low-glucose suspend (LGS) feature. Results A total of 2716 LGS alerts occurred, and 48.6% began in the afternoon between 4PM and 7PM. The mean duration of LGS events was 26.5 min, 38% lasted for <5 min and 5.3% lasted for 120 min. Among these episodes, the mean sensor glucose was 62.3 +/- 5.96 mg/dL at LGS activation, rose to 129.8 +/- 11.6 mg/dL by the end of the LGS episode (when insulin delivery was automatically resumed) and was 155.6 +/- 11.1 mg/dL at 240 min. LGS usage significantly reduced area under the curve (AUC) <70, AUC <60 mg/dL (p=0.0001) and >240 mg/dL (p=0.006). None of the LGS-on group broke their fast versus 15 in the second group (p=0.001). No episodes of severe hyperglycaemia or DKA were noticed in either groups. Conclusions Usage of low-glucose suspend (LGS) significantly reduced exposure to hypoglycaemia without compromising safety. Copyright (C) 2016 John Wiley & Sons, Ltd.