1742-P: Ramadan Fasting and Glycemic Control among Insulin-/Sulfonylurea-Treated Patients with Type 2 Diabetes: A Prospective Study from Saudi Arabia

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Introduction and Objective: Use of insulin and/or sulfonylurea (SU) during Ramadan fasting increases the dysglycemia risk among people with type 2 diabetes (PWT2D). We compared efficacy and safety profiles across 4 commonly used treatment regimens during Ramadan Methods: PWT2D were categorized into 4 groups based on insulin and SU use: Multiple daily injections (MDI; n=67), Combined Basal insulin (BI) and SU (BI+SU; n=30), BI alone (BI; n=23), and SU alone (SU; n=24). Concomitant use of other treatments (metformin, DPP-4i, and SGLT2i, etc) was permitted across all groups; and continuous glucose monitoring (CGM) was used to assess glycemic outcomes during Ramadan Results: During Ramadan, percent time in range (TIR) differed significantly across treatment groups: 46.90 (MDI), 59.98 (BI+SU), 60.53 (BI), and 64.55 (SU) (p=0.01). The Glycemia Risk Index (GRI) during Ramadan was highest in the MDI group (59.83), followed by BI+SU (40.66), BI (41.24), and SU (36.60) (p<0.01). The proportions of PWT2D achieving the “double CGM target” (TIR>70% and TBR<4%) for the MDI, BI+SU, BI, and SU groups were 20.97, 28.57, 40.91, and 54.55%, respectively (p=0.02). The proportions of PWT2D with a diabetes-related ER visit during Ramadan was highest in the MDI group (8.96%), followed by BI+SU (3.33%), and lowest in the BI (0%) and SU groups (0%) (p=0.17). The proportions of PWT2D who achieved the “fasting double target” (broke the fast because of diabetes ≤2 days and had Ramadan TIR>70%) were lowest in the MDI group (25.81%), followed by Basal+SU (28.57%) and BI (45.45%), and highest in the SU group (50%) (p=0.11). Users of SU alone and BI alone were 3.8 and 3.1 times likelier, respectively, to achieve the fasting double target compared with MDI users after adjusting for age, gender, employment/insurance status, educational level, age at diabetes diagnosis, and diabetes duration Conclusion: Use of MDI or combined BI and SU therapy in PWT2D during Ramadan was associated with poorer glycemic control and fasting experience compared with the use of BI or SU alone. 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. H. Albalawi: None. S.K. Alharthi: None. F. Alam: None. A.S. Alangri: None.

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