Gestational diabetes mellitus (GDM) is a condition in which a hormone made by the placenta prevents the body from using insulin effectively. Glucose builds up in the blood instead of being absorbed by the cells.

1. JOURNAL ARTICLE:
MUKESHSAH
POSTGRADUATE MEDICAL INTERN
GOODSAM MEDICALCENTER

3.  Objective
Women with gestational diabetes mellitus (GDM) are categorized as
at high risk for adverse events during Ramadan fasting. However, this
is largely based on clinical opinion. In this study, we shed some light on
whathappens to glucose levels during Ramadan fasting.

4.  Methods
 This is a prospective observational study. A total of 32 patients with
GDM were recruited; 10 patients, treated with diet only (group 1), to
observe their glucose levels before fasting and 22 patients who
insisted on fasting the month of Ramadan, 13 treated with diet only
(group 2) and nine treated with diet plus metformin 500 mg twice
daily (group 3), to evaluate their glucose levels during fasting.
Interstitial glucose was monitored in all by using the iPro2
Professional continuous glucose monitoring (CGM) system.

5.  Results
 Mean glucose level was 116±21 mg/dL (6.16±1.16 mmol/L), 106±9
mg/dL (5.88±0.49 mmol/L) and 99±7 mg/dL (5.49±0.34 mmol/L) in
groups 1, 2 and 3, respectively. Patients in group 1 had the lowest
rate of hypoglycemia (50%), followed by patients in group 2 (60%),
whereas patients in group 3 had the highest rate of hypoglycemia
(78%).

6.  Conclusions
 CGM data indicates that Ramadan fasting in women with GDM
treated with diet alone or with diet plus metformin was associated
with lower mean glucose levels and higher rates of hypoglycemia
when compared with non-fasting glucose levels. Women with GDM
should be advised against fasting during Ramadan until further data
is available.

7.  What is already known about this subject?
 The vast majority of Muslim women with gestational diabetes opt to
fast in the month of Ramadan despite medical/religious advice not
to do so.
 Most of the medical recommendations are based onexpert opinion
due to the paucity of clinical studies in this field.

8.  What are the new findings?
 Our data suggest that Ramadan fasting increases the risk of
hypoglycemia in women with GDM treated with diet alone or with
diet±metformin.
 The impact of metformin on the glucose changes compared with
diet only is of great clinical interest. It was associated with reduced
risk of hyperglycemia and lower rate of severe hypoglycemia,
however, with an increased risk o mild-moderate hypoglycemia
when compared with diet alone during fasting.

9.  How might these results change the focus of research or
clinical practice?
 The data is an important step in risk quantification for women with
GDM wishing to fast Ramadan.
 Women with GDM should be advised against fasting during
Ramadan until further data is available.
 Continuous glucose monitoring could be of good value for
understanding the blood glucose changes in patients with GDM
treated with diet alone or with diet±metformin pre-Ramadan and
during Ramadan fasting.

11.  January 2018

12.  Background:
 Infants of diabetic mothers have been shown in several studies to
have an increased frequency of malformations. In previous studies,
an increased frequency of several specific malformations has been
noted, including anencephaly, bilateral renal agenesis, and double
outlet right ventricle Surveillance, used to identify all malformed
infants in a consecutive sample of births, can identify a distinctive
pattern of malformations among the affected infants.

13.  Methods:
 The infants of insulin-dependent, pregestational diabetic mothers
were identified in the daily review of the medical records of each
newborn infant with a malformation and her/his mother’s medical
record. Infants of mothers with gestational diabetes were excluded.
The frequency of each malformation was compared to that among
the malformed infants of nondiabetic mothers.

14.  Results:
 One hundred and eighty-three malformed infants of diabetic
mothers were identified among the 289,365 births.The most
notable malformations were: neural tube defects (anencephaly, 9%),
heart defects (transposition of great arteries, 4%), bilateral renal
agenesis or dysgenesis (6%), and vertebral anomalies
(hemivertebrae, 4%).

15.  Conclusions:
 There was a recognizable pattern of malformations and
characteristics of infants of diabetic mothers, although there was
variation in the pattern among affected infants. Some of the
malformations in the diabetic embryopathy can be identified in
prenatal screening by ultrasound. More important, their occurrence
can be reduced significantly by the mother achieving much better
control of her diabetes mellitus prior to conception.