{
  "abstract": "Objective\n\nThe effect of basal insulin timing on hypoglycemia during Ramadan fasting remains uncertain despite recommendations to administer basal insulin earlier in the evening. We evaluated whether early evening compared with bedtime administration of insulin glargine reduces hypoglycemia and improves glycemic outcomes in individuals with type1 diabetes (T1D) fasting during Ramadan.Methods\n\nThis multicenter open-label randomized controlled trial was conducted across 4 centers in Saudi Arabia. Participants with T1D intending to fast Ramadan were randomized to early evening or bedtime glargine administration. Glucose data were collected using self-monitoring of blood glucose (SMBG), intermittently scanned continuous glucose monitoring (FreeStyle Libre), and blinded continuous glucose monitoring (CGM; Medtronic iPro2).Results\n\nA total of 185 participants were analyzed (91 early evening, 94 bedtime). Baseline characteristics were similar between groups. Fasting interruption occurred in 75.9% versus 76.3% of participants (P = .94), with hypoglycemia accounting for >90% of interruptions in both groups. Hypoglycemia occurred predominantly during the morning period regardless of basal insulin timing. Severe hypoglycemia was reported in 2 versus 5 participants, and 1 diabetic ketoacidosis admission occurred in each group. Continuous glucose monitoring-derived glycemic metrics were similar between groups. Time in range (70-180 mg/dL) was 44.6% versus 46.1% (P = .70), time below range (<70 mg/dL) was 7.9% versus 6.4% (P = .35), and time above range (>180 mg/dL) was 47.5% in both groups (P = .99). Self-monitoring of blood glucose-detected hypoglycemic episodes and CGM-detected low glucose excursions were also comparable. Area under the curve below range was higher in the early evening group (P = .04).Conclusion\n\nChanging insulin glargine administration from bedtime to earlier evening hours during Ramadan fasting did not significantly reduce hypoglycemia or improve overall glucose profiles in individuals with T1D. These findings suggest that routine universal shifting of basal insulin timing during Ramadan may not be necessary and support an individualized approach based on patient preference and glucose patterns.Clinicaltrials\n\ngov identifier: NCT04383990.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Medicine, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.",
    "King Abdulaziz Hospital, Ministry of National Guard Health, Al Ahsa, Saudi Arabia.",
    "King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health, Riyadh, Saudi Arabia.",
    "King Abdullah International Medical Research Center, Ministry of National Guard Health, Riyadh, Saudi Arabia.",
    "King Abdulaziz Medical City, Ministry of National Guard Health, Jeddah, Saudi Arabia.",
    "Chair of Biomarkers of Chronic Diseases, College of Science, King Saud University, Riyadh, Saudi Arabia.",
    "King Abdulaziz Medical City, Ministry of National Guard Health, Riyadh, Saudi Arabia.",
    "XPERTCARE Clinic, Dubai, United Arab Emirates."
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Reem Alamoudi",
      "orcid": "0000-0002-2728-9946"
    },
    {
      "affs": [
        1,
        2,
        3
      ],
      "name": "Ali Alqarni",
      "orcid": "0000-0002-2413-6637"
    },
    {
      "affs": [
        1,
        2,
        3
      ],
      "name": "Maram Alsubaiee"
    },
    {
      "affs": [
        4
      ],
      "name": "Ghofran Khogeer"
    },
    {
      "affs": [
        2,
        5,
        6
      ],
      "name": "Yousef Saleh"
    },
    {
      "affs": [
        4
      ],
      "name": "Abdulrhman Aljawharji",
      "orcid": "0009-0001-5391-9593"
    },
    {
      "affs": [
        0,
        2,
        3,
        4
      ],
      "name": "Hawazen Zarif"
    },
    {
      "affs": [
        0,
        2,
        3,
        4
      ],
      "name": "Salwa Alaidarous"
    },
    {
      "affs": [
        3
      ],
      "name": "Seham Khashwayn",
      "orcid": "0009-0003-6516-9608"
    },
    {
      "affs": [
        7
      ],
      "name": "Mohamed Hassanein"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/15e1napcz851w.bib",
  "cited_by": 0,
  "doi": "10.1177/19322968261493574",
  "fulltext_url": "https://europepmc.org/articles/PMC13676690",
  "id": "15e1napcz851w",
  "issns": [
    "1932-2968"
  ],
  "landing_url": "https://europepmc.org/article/MED/42891564",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2712|Diabetes Management and Research"
    ]
  ],
  "openalex": "W7222833456",
  "pdf_url": "https://europepmc.org/articles/PMC13676690?pdf=render",
  "pmcid": "PMC13676690",
  "pmid": "42891564",
  "published": "2026-10-17",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/15e1napcz851w.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:46Z",
      "native_id": "MED:42891564",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42891564"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2712|Diabetes Management and Research",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "Timing of Insulin Glargine Administration During Intermittent Ramadan Fasting in patients With Type1 Diabetes: A Randomized Controlled Trial (GLARIF).",
  "title_text": "Timing of Insulin Glargine Administration During Intermittent Ramadan Fasting in patients With Type1 Diabetes: A Randomized Controlled Trial (GLARIF).",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:18:46Z",
  "url": "https://research.draconitic.com/paper/15e1napcz851w",
  "venue": "Journal of diabetes science and technology",
  "versions": []
}