• Melika Chihaoui, Wafa Grira, Jihene Bettaieb, Meriem Yazidi, Fatma Chaker, Ons Rejeb, Ibtissem Oueslati, Moncef Feki, Naziha Kaabachi, and Hedia Slimane.
• Department of Endocrinology, University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Tunis, Tunisia. Electronic address: melikachihaoui@yahoo.fr.
• Nutrition. 2018 Jan 1; 45: 99-103.

ObjectivesThe risk for hypoglycemia during Ramadan fasting in patients with adrenal insufficiency (AI) is not fully known. The aims of this study were to evaluate this risk objectively and to determine the associated factors.MethodsThis prospective case-crossover study included 25 women and 5 men with known and treated AI and a median age of 38.5 y. Patients underwent clinical examination and a fasting blood sample was collected to measure glucose, urea, creatinine, sodium, potassium, cortisol, growth hormone and free thyroxine. A 24-h continuous glucose monitoring system (CGMS) using iPro2 (Medtronic, Parsippany, NJ, USA) with Enlite sensor (Medtronic) was performed for each patient during a Ramadan fasting day then again during a nonfasting day.ResultsInterstitial glucose levels during the 24-h period, the fasting period, and the fasting period after exclusion of the 5 postprandial hours were significantly lower during the fasting day than on the nonfasting day. Hypoglycemia occurred in three patients (10%) during the fasting day but not during the nonfasting day (P = 0.23). Hypoglycemia was asymptomatic in two cases. Male sex was significantly associated with the occurrence of hypoglycemia.ConclusionInterstitial glucose levels were lower during fasting in patients with AI. However, the risk for hypoglycemia was not increased.Copyright © 2017 Elsevier Inc. All rights reserved.

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