1916-P: Pre-Ramadan CGM Metrics Predicting Achievement of Fasting and Time-in-Range Targets during Ramadan in High-Risk People with Type 2 Diabetes

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Introduction and Objective: The 2026 American Diabetes Association (ADA) Standards of Care do not incorporate pre-Ramadan continuous glucose monitoring (CGM) metrics into the Ramadan fasting risk calculator. We examined changes in CGM metrics from pre-Ramadan to during Ramadan among people with type 2 diabetes (PWT2D) and identified pre-Ramadan CGM predictors of fasting experience and glycemic control during Ramadan Methods: PWT2D were categorized into 2 groups based on achieving the fasting double target, defined as breaking the fast because of diabetes on ≤2 days and achieving a Ramadan time in range (TIR) of >70%. Pre-Ramadan CGM metrics were compared between the two groups. Changes in CGM metrics from pre-Ramadan to Ramadan were examined across 4 treatment regimens: multiple daily injections (MDI), basal insulin (BI), BI and sulfonylurea (BI+SU); and (SU). Logistic regression was used to identify pre-Ramadan CGM predictors of achieving the fasting double target Results: Percent time in range (TIR) decreased from pre-Ramadan to Ramadan across all treatment groups: MDI (52.22 to 46.83, p<0.05); BI+SU (69.21 to 61.26, ); BI (66.14 to 59.32, p>0.05); and SU (71.08 to 64.55, p<0.05). Similarly, glycemia risk index (GRI) increased during Ramadan: MDI (51.65 to 59.78, p<0.05); BI+SU (31.50 to 40.11, p<0.05); BI (33.91 to 44.52, p>0.05); and SU (30.05 to 36.60, p<0.05), driven primarily by hyperglycemia. After adjusting for age, gender, employment/insurance status, educational level, age at diabetes diagnosis, and diabetes duration, the following pre-Ramadan CGM metrics independently predicted achievement of the fasting double target: TIR70-180>70%, TBR<54 >1%, TAR>180 <25%, TAR>250 <5%, and GRI<40 Conclusion: Pre-Ramadan CGM metrics are clinically meaningful predictors of fasting experience and glycemic control during Ramadan. Incorporating these metrics into the ADA Ramadan fasting risk calculator may improve risk stratification and individualized counseling for PWT2D who plan to fast Disclosure M.E. Al-Sofiani: Speaker's Bureau; Ended; Medtronic, Dexcom, Inc. Research Support; Current; Dexcom, Inc. Research Support; Ended; Medtronic. Speaker's Bureau; Ended; Insulet Corporation, Abbott Diabetes, Sanofi. S.K. Alharthi: None. H. Albalawi: None. A.S. Alangri: None. F. Alam: None.

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