Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with Type 1 diabetes mellitus who fast during Ramadan: A systematic review and meta-analysis

Hoda Gad, Hamad Al-Muhannadi, Paul Mussleman, Rayaz Malik

Research output: Contribution to journalReview article

3 Citations (Scopus)


Background: The benefits and risks of continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) in patients with Type 1 diabetes mellitus (T1DM) who fast during Ramadan are not known. Methods: Systematic review and meta-analysis of observational studies conducted in PubMed, Embase (Ovid), and the Cochrane Library. Quality of included studies was assessed using the ROBINS-I tool for risk of bias assessment and analyses were performed using RevMan version 5.1. Results: From 709 records, 306 full text studies were assessed. After exclusions, the final analysis included a total of 9 studies. Heterogeneity for outcomes was I 2 = 0%. There was no significant difference for the change in glycemic control (HbA 1c ) between CSII and MDI (P > 0.05). There was no change in weight or the lipid profile in patients with T1DM on MDI during Ramadan. There were insufficient data to assess the impact on glucose profiles and the incidence of hypoglycemia or diabetic ketoacidosis (DKA) in patients on CSII or MDI during Ramadan. Conclusions: Studies assessing the effect of CSII or MDI in patients with T1DM who fast during Ramadan are limited to observational studies and show no difference in the change in Hb A1 c, weight or lipids during Ramadan.

Original languageEnglish
JournalDiabetes Research and Clinical Practice
Publication statusPublished - 1 Jan 2019



  • CSII
  • MDI
  • Metabolic control
  • Ramadan fasting
  • T1DM

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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