Effects of Alternate Insulin Pump Settings in Patients With Type 1 Diabetes During Ramadan: A Randomized Pilot Study

BACKGROUND: Various studies have evaluated the safety and efficacy of using insulin pumps during Ramadan; some of them demonstrated favorable outcomes in reducing hypoglycemia and hyperglycemia. However, there is no consensus on the recommendations for basal insulin adjustments and the utilization of technical features of insulin pumps to improve glycemic control. OBJECTIVES: We aimed to investigate the effects of different insulin pump settings on time in range in patients with type 1 diabetes during Ramadan. METHODS: In this randomized pilot study, 30 patients classified to have low to moderate risk for fasting were assigned to either a control group to receive basal insulin adjustments only or an intervention group to use the temporary basal rate and extended bolus features in addition to the basal insulin modifications. The percentage of time spent at different glucose ranges was measured by continuous glucose monitoring. RESULTS: The percentage of time spent within target (70-180 mg/dL) increased significantly in the intervention group from 63.0 ± 10.7 to 76 ± 16.2% (mean difference, 27% points; P < .001). The percentage of time spent in hyperglycemia level 1 (>180 mg/dL) and level 2 (>250 mg/dL) met the criterion of significance, indicating that the intervention group spent less time in hyperglycemia. However, there was no significant difference in the percentage of time spent in hypoglycemia ranges. CONCLUSIONS: Incorporating technological approaches of pump therapy with clinical practice guidelines could improve glycemic control during Ramadan.