Early Versus Late Administration of Insulin Glargine in T1DM During Fasting Ramadan
Early Versus Late Administration of Insulin Glargine in T1DM During Fasting Ramadan
To compare different timing of insulin Glargine administration (early-6 pm versus standard
 bedtime-10 pm) as part of standard of care in patients with type1 diabetes who wish to fast
 the month of Ramadan.
The investigators aim to compare the effectiveness and safety of two management strategies
 currently used in basal insulin adjustment for treatment of Type1 diabetes (T1DM) during
 fasting the holy month of Ramadan.

 Primary Objective:

 To determine if taking basal insulin Glargine at 6 pm is associated with less rates of
 hypoglycemia -(we will consider glucose level of 70 mg/dl ( 3.9 mmol/l) and below as the
 level of hypoglycemia ) - compared to bedtime timing (10-12pm) during fasting Ramadan in
 patients with T1DM

 Secondary Objectives:

 1. To estimate the difference between the two groups in glucose variability

 2. To estimate the difference between the two groups in number of days they needed to brake
 their fast

 3. To assess the difference in glycemic control between the two groups

 4. To estimate the difference between the two groups in overnight and daytime
 hyperglycemia.

 5. To estimate the difference between the two groups in rate of severe hyperglycemia and
 /or DKA

 It is a multi-center open label randomized study that will take place in the
 diabetes/Endocrine clinics at National Guards Hospitals in four cities (Jeddah, Riyadh,
 Alhasa, and Dammam)

 Variables to be Assessed:

 1. Patient's demographics including (age, gender, type and duration of diabetes), and
 baseline measurements (weight, height,BMI, …).

 2. Rate of Hypoglycemic events (as per SMBG records and CGM) in both groups

 3. Number of days fasting was broken in both groups

 4. Rate of severe hyperglycemic episodes (BG>250mg/dl) or DKA in both groups

 5. Mean blood glucose for the month of Ramadan as calculated from sum of each patient's
 7-point blood sugar home measurements in both groups.

 6. Mean 24-hour blood glucose as measured by a continuous glucose monitoring devise in both
 groups.

 7. Mean fasting blood glucose for the month period as calculated from patients home blood
 sugar measurements in both groups.

 8. Mean 2-hour post-prandial blood glucose for the as calculated from patients home blood
 sugar measurements in both groups.

 9. Fructosamine and HbA1c level before and after Ramadan in both groups

 Results of this study will help fill a current gap of knowledge and may also contribute to
 the development of future guidelines for the management of type1DM during Ramadan.
Inclusion Criteria:

 1. DM type 1

 2. Age > 14 years

 3. Diagnosis of type 1 DM of more than 6 months.

 4. Committed to do SMBG

 Exclusion Criteria:

 1. Renal and hepatic impairment

 2. Adrenal insufficiency

 3. Pregnancy

 4. Alcohol consumption

 5. Any diagnosed psychiatric disease