Fasting during the holy month of Ramadan among older children and adolescents with type 1 diabetes in Kuwait

Background: To evaluate the safety of fasting during the holy month of Ramadan among children and adolescent with type 1 diabetes (T1D). Methods: A retrospective cohort study of 50 children and adolescents with T1D whose mean age was 12.7 +/- 2.1 years was conducted. Twenty-seven patients (54%) were on multiple daily injections (MDI) insulin regimen and 23 (46%) were on insulin pump therapy. Before fasting for Ramadan, children and their families were evaluated and educated about diabetes management during Ramadan. Hemoglobin A(1c )(HbA(1c)), weight, number of days fasted, hypoglycemia and hyperglycemia episodes, and emergency hospital visits were collected and analyzed after completing the month. Participants were compared according to the insulin treatment regimen and their glycemic control level before Ramadan. Results: The children were able to fast 20 +/- 9.9 days of Ramadan, and the most common cause for breaking the fast was mild hypoglycemia (7.8% among all cases). There was no significant difference between the two insulin regimen groups in breaking fast days, frequency of hypo- or hyperglycemia, weight and HbA(1c )changes post Ramadan. Patients with HbA(1c) <= 8.5% were able to fast more days during Ramadan with significantly less-frequent hypoglycemic attacks as compared to patients with HbA(1c)>8.5 (1.2 +/- 1.5 vs. 3.3 +/- 2.9 days of hypoglycemia, p = 0.01, respectively). Conclusions: Fasting for children with T1D above the age of 10 years is feasible and safe in both pump and nonpump users, and well-controlled patients are less likely to develop complications. Education of the families and their children before Ramadan, along with intensive monitoring of fasting children during the month are crucial.