Hypoglycaemia and other risks of ramadan fasting in patients with primary adrenal insufficiency: A prospective controlled trial using 24-hour glucose monitoring.

backgroundPatients with primary adrenal insufficiency (PAI) are at increased risk of hypoglycaemia and dehydration. We aimed to evaluate the risk of complications, particularly hypoglycaemia, associated with Ramadan fasting (RF) in patients with PAI, using continuous glucose monitoring (CGM).

methodsIn this prospective, randomised, crossover, case-control study, we evaluated the prevalence of complications using clinical, biological and CGM data during RF and non-fasting days in 30 patients with PAI. All participants were treated with hydrocortisone and fludrocortisone and received a therapeutic education.

results27 women and 3 men, mean age: 44.8±9.2 years, median duration of PAI: 7 years (4-10.5). Median daily doses were 20 mg of hydrocortisone and 50 µg of fludrocortisone. The prevalence of complications was 67% during RF and 23% outside RF (p = 0.001). Eleven patients (37%) broke the fast due to the occurrence of a complication. Signs of hypoglycaemia were reported by 37% of the patients during RF and 3% outside fasting (p = 0.002). Mean interstitial glucose levels were lower during fasting than outside fasting. The prevalence of CGM-detected hypoglycaemia (71% vs. 63%, p = 1.000), time spent below 3.9 and 3.0 mmol/l, and blood pressure levels were not different between RF and non-fasting days. Urea levels increased during RF but remained within normal limits.

conclusionComplications were frequent during RF in patients with PAI. Hypoglycaemia was frequent both during and outside RF. Registered on Clinical Trials on February 28th, 2024, under the identifier NCT06299020.