Glycemic profile of three different insulin regimes during the month of Ramadan

• Main Authors: Omar, Mohd Rahman, Muhayidin, Azura Dina, A. Wahab, Norasyikin, Shahar, Mohammad Arif, Wan Seman, Wan Juani, Omar, Ahmad Marzuki, Mustafa, Norlaila, Sukor, Norlela, Kamaruddin, Nor Azmi
• Format: Conference or Workshop Item
• Language: English
• Published: Malaysian Endocrine & Metabolic Society (MEMS) 2016
• Subjects: RC Internal medicine
• Online Access: http://irep.iium.edu.my/52038/1/glycemic%20profiles%20of%203%20insulin%20regimes%20in%20ramadan.pdf; http://irep.iium.edu.my/52038/; http://www.jmems.org

Introduction: Based on the EPIDIAR study 2001, about 79% of type 2 diabetic Muslims fast, 9.4% of them were on insulin alone and 7.3% on combination with oral antidiabetic agent with the incidence of hypoglycaemia increasing by a ratio of 7 times and hyperglycaemia crisis by 5 times, patients who are on insulin at high risk of acute complications. Aim: To determine the glycaemic profile as well as to evaluate acute complications in particular hypoglycaemia and hyperglycaemia among type 2 diabetic patients who were on 3 insulin regimes during Ramadan. Methods and Design: This was a prospective study conducted at the outpatient endocrine clinic involving type 2 diabetic Muslims who were on insulin therapy. The self-monitoring blood glucose were done on 3 consecutive days at the end of each treatment period at pre-iftar (break of fast), 2 hours post-iftar (break of fast), pre-sahur (dawn), 2 hours post-sahur (dawn), 12 noon and at any time when symptomatic of hyperglycaemia or hypoglycaemia. Patients were divided to 5 groups, those on 1) A - oral antidiabetic agents with Insulatard taken at prebed, 2) B - oral antidiabetic agent with insulatard taken at presahur 3) C - twice a day pre-mixed insulin 4) D - basal bolus regime with insulatard taken at prebed and 5) E - basal bolus regime with insulatard taken at presahur. Results: Out of 195 patients, 86 (44.1%) were males and 109 (56.2%) were females. The baseline characteristics are listed table 1. There was significant reduction of fructosamine (p= 0.002) in all groups compared to baseline but not for A1c (p=0.224). (There was significant higher frequency of hyperglycaemia in those who received basal-bolus (group D and E) compared to other groups (80% (60, 93) and 80% (64,93) compared to A (63.3%(38.9,89.3), B=55.5%(43.1,93.3), C=(66.7%(49.3,91.1) p=0.025). The pre-iftar (p=< 0.001) and noon (p=0.029) mean glucose levels were significantly lower in group B compared to other groups. There was also significantly lower presahur mean glucose level in group A compared to other groups (p=0.01). However, there was no significant different in the post prandial mean glucose in all groups (p =0.478 and p=0.875).(table 2) There was significantly lower frequency of hypoglycemia in the basal bolus group compared to other groups respectively (6.1 % vs 4.7% vs 3.8 % vs 1.4 % vs 1.4 %, p=0.004). Conclusion: Fasting during Ramadan in type 2 diabetic patients resulted in improved glycemic control based on reduction serum fructosamine. There was higher frequency of hyperglycemia in those who received basal bolus insulin regardless time received basal insulin. The significant hyperglycaemia seen post iftar and post sahur were likely contributed by higher baselineA1c and FBS.