Automated Insulin Delivery Systems Are Safe During Prolonged Religious Jewish Fasting Among Adolescents and Young...

To evaluate the outcomes of prolonged religious Jewish fasting in individuals with type 1 diabetes using automated insulin delivery (AID) systems.

This cross-sectional, non-interventional study assessed the effects of a 25-hour Jewish fast in individuals using AID systems. Data was collected on the day of the fast, one week before, and one week after.

The study included data from 109 fasting days involving 80 adolescents and young adults with type 1 diabetes. The mean age of participants was 17.4 ± 4.1 years; 47.5% were male, and the average duration of diabetes was 7.2 ± 4.3 years. A total of 67.6% of participants modified their AID system settings during the fasting period, with the most common modification being a change in the target glucose level. Overall, 71.5% completed the fast without complications. Fasts were primarily broken because of sensor-detected hypoglycemia. No cases of severe hypoglycemia or diabetic ketoacidosis were reported during or after the fasting period. During the fast, the mean blood glucose level was 135 ± 28.6 mg/dL, time in range (70-180 mg/dL) was 80.7%, and time spent in hypoglycemia (<70 mg/dL) was 2.6%.

Prolonged fasting appears to be safe for adolescents and young adults with type 1 diabetes using AID systems. However, individualized adjustments to system settings are often necessary to maintain glycemic stability during fasting. To our knowledge, this is the first report of the effects of using an AID system during Jewish religious fasting.