ArticleFrontiers in endocrinology2026
Pre-Ramadan time-below-range stratifies the simulated pump basal-rate dose-response during Ramadan fasting: a five-policy paired virtual-patient study.
Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Pump basal-rate reduction during Ramadan may prevent hypoglycemia but can increase hyperglycemia. Its dose-response relation and phenotype-dependent trade-off remain uncertain. Methods: Thirty UVA/Padova virtual patients (10 children, 10 adolescents, 10 adults) underwent paired 30-day Ramadan conditions delivering 100%, 90%, 80%, 70%, or 60% of the pump steady-state basal rate. The primary complete-case analysis included 29 virtual patients. Outcomes were time in range (TIR), time below range (TBR), time above range (TAR, including TAR Results: Mean TIR was 81.7%, 79.9%, 73.9%, 65.3%, and 56.0% at 100%, 90%, 80%, 70%, and 60%, respectively ( Conclusion: Ramadan pump basal-rate reduction should be treated not as a uniform percentage change but as a phenotype- and context-dependent trade-off. Among the reduced policies, 90% basal produced the smallest TIR loss while lowering hypoglycemia; pre-Ramadan TBR was an exploratory candidate stratifier; and meal-size associations differed by policy. These mechanistic findings apply to simulated pump basal-rate modulation and require prospective, CGM-anchored validation before any clinical use.
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