ArticleDiabetes, obesity & metabolism2025
Potential benefits of hybrid closed-loop systems for managing moderate- to high-risk individuals with type 1 diabetes during Ramadan fasting.
Article in Diabetes, obesity & metabolism, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Pre-Ramadan time-below-range stratifies the simulated pump basal-rate dose-response during Ramadan fasting: a five-policy paired virtual-patient study.Frontiers in endocrinology · 2026Article
- Potential benefits of hybrid closed-loop systems for managing moderate- to high-risk individuals with type 1 diabetes during Ramadan fasting.Diabetes, obesity & metabolism · 2025Article
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8 authors.
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Abstract
aimWe evaluated whether using hybrid closed-loop systems (HCL) provides a safer, more effective fasting experience compared with multiple daily injections with continuous glucose monitoring (MDI + CGM) for people with T1D at moderate-to-high risk in a real-world setting. MATERIALS AND
methodsIn this multicentre prospective study, 178 adults with T1D [HCL n = 98 (39 males 59 females); MDI + CGM n = 80 (30 males 50 females)] who chose to fast in Ramadan of 2024 were assessed for clinical and glycaemic profiles and risk stratified according to the International Diabetes Federation-Diabetes and Ramadan (IDF-DAR) criteria. The composite endpoint was completing >15 days of fasting and achieving time in range (TIR) ≥70%, with time below range (TBR) <4%.
resultsAt baseline, the MDI + CGM group was older than the HCL group (mean ± standard deviation, 29.2 ± 9.6 vs. 26.3 ± 9.4 years) (p = 0.049). Half of the HCL participants met the composite endpoint versus only 8% of MDI + CGM users (p < 0.001). Similarly, participants in the HCL group were able to complete all possible fasting days more frequently than the MDI + CGM group (p < 0.05). The use of HCL was associated with nine-fold higher odds ratio (OR) (9.4 [95% confidence intervals 3.1-28.4]) of achieving the composite endpoint.
conclusionsFor moderate-to-high risk individuals with T1D, HCL substantially improves the safety and feasibility of prolonged daytime fasting during Ramadan, outperforming MDI + CGM in achieving glycaemic and fasting targets. While the results favour HCL, causal inference is still limited, given the lack of randomization and cross-over design. Concurrently, there is a need to update current recommendations for high-risk populations and underscore the central role of advanced diabetes technology in Ramadan.
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