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Insulin-to-carbohydrate ratio intensification during Ramadan in young people using advanced hybrid closed-loop
Asma Deeb1, Nadha Yaqoob2, Reem Hassan Beck3
1Paediatric Endocrine Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates; Gulf Medical School, Ajman, United Arab Emirates; Faculty of Health & Science, Khalifa University, Abu Dhabi, United Arab Emirates.
Aims:
This study evaluated whether intensifying the insulin-to-carbohydrate ratio (ICR) during the non-fasting period is associated with improved glycemic control without increasing hypoglycemia in young people with type 1 diabetes (T1D) using advanced hybrid closed-loop (AHCL) therapy during Ramadan.
Methods:
In this prospective quasi-experimental pilot study, MiniMed 780G AHCL users fasting during Ramadan 2025 were allocated to standard care or 20% ICR intensification from Iftar to Suhoor (18:00-06:00). Continuous glucose monitoring (CGM) metrics were analyzed over Ramadan for the full 24-hour and non-fasting periods. The primary efficacy outcome was non-fasting time in range (TIR; 70-180 mg/dL); the primary safety outcome was non-fasting time below range (TBR; <70 mg/dL).
Results:
Of 61 enrolled participants, 47 (29 control, 18 intervention; median age 14.9 years) were included in the analysis following post-Ramadan attrition. In an adjusted analysis (pre-specified linear regression including age and baseline HbA1c), ICR intensification was associated with a 10.4% higher non-fasting TIR (95%CI 5.2-15.5; p = 0.0002). Non-fasting TBR remained low and similar between groups, with no evidence of increased hypoglycemia.
Conclusions:
Prandial insulin intensification may be a safe strategy worthy of further investigation of its potential to improve glycemic control during Ramadan in young people using ACHL therapy.
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