Smartphone‐Based Automated Basal Insulin Titration During Ramadan Fasting: Data From Adults With Type 2 Diabetes in Saudi Arabia

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BACKGROUND: Many people with type 2 diabetes (PWT2D) using insulin are advised not to fast during Ramadan because of dysglycemia risk. Here, we examined the efficacy and safety of using a smartphone application to titrate basal insulin doses to fasting blood glucose (FBG) target 70-130 mg/dL in PWT2D who practiced Ramadan fasting. METHODS: We retrospectively analysed data from 106 PWT2D using basal insulin and My Dose Coach (MDC) who fasted during Ramadan 2022-2024 and had FBG data pre-, during, and after Ramadan. Per standard of care, those with pre-Ramadan FBG < 130 mg/dL had basal insulin doses reduced by 20% (Reduced Basal 'RB' Group). Those with pre-Ramadan FBG ≥ 130 mg/dL continued usual doses (Usual Basal 'UB' Group). During Ramadan, MDC guided basal insulin titration based on pre-sunset FBG. RESULTS: Average FBG levels in the RB and UB groups were: pre-Ramadan (120 vs. 145 mg/dL, p < 0.01), week-1 (129 vs. 139 mg/dL, p = 0.14), week-2 (131 vs. 141 mg/dL, p = 0.13), week-3 (130 vs. 138 mg/dL, p = 0.07), week-4 (129 vs. 138 mg/dL, p = 0.11), and post-Ramadan (126 and 138 mg/dL, p = 0.03). In the RB group, the MDC app increased the average basal insulin dose from 29 units in Ramadan Week 1 to 33 units by Week 4; similarly, in the UB group, the mean dose increased from 34 to 38 units. The proportion of PWT2D with FBG 70-130 mg/dL was maintained throughout Ramadan in both groups with no documented FBG < 70 mg/dL. CONCLUSION: Use of smartphone-based automated basal insulin titration during Ramadan fasting is effective in maintaining FBG levels within target in PWT2D.

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