Jakarta, IO – Type 1 diabetes mellitus (Type 1 DM) is a chronic metabolism disorder resulting from insufficient insulin levels, in turn related to autoimmune disorders. The number of Type 1 DM incidence is 2%-5% a year, and it occurs evenly worldwide. There is no national data concerning the prevalence of the disease in Indonesia, but data registered by the Indonesian Pediatricians Association (Ikatan Dokter Anak Indonesia – “IDAI”) shows that the 156 Type 1 DM child and teen sufferers diagnosed in 2009 have increased to 1,160 sufferers in 2014, and again to 1,368 sufferers by 2021. The increased prevalence of the disease means that we need to pay better attention to diabetes treatment for children and teens, including when fasting in Ramadan.
On Monday (02/01/2023), dr. Bambang Tridjaja AAP, Sp.A(K), MM(Paed), declared in his doctoral thesis defense at the University of Indonesia Faculty of Medicine Doctorate Program that Type 1 DM sufferers have a higher risk of acute diabetic complications when fasting, such as hypoglycemia (lower blood sugar levels than normal), hyperglycemia (higher blood sugar levels than normal), and diabetic ketoacidosis (increased DM severity wherein the liver speeds up the breakdown of fat in the body because of insufficient insulin levels), which means that it is recommended for them to Ramadan. Multiple studies have reported the increase of the risk of acute complications among fasting adult DM sufferers, but evidence-based studies for the safety of fasting among child and teen Type 1 DM sufferers are rare.
“Experts emphasize that pre-Ramadan education and metabolic control of the disease (with the clinical parameter HbA1c) are primary factors in fasting safety. Education, as part of the five pillars of daily Type 1 DM treatment regime (education, administration of insulin, diet regime, physical exercise regime, and daily blood sugar monitoring), needs to be solidified when facing special situations, such as fasting during the Ramadan. We recommend using a psychoeducational approach when educating new DM sufferers,” reported dr. Bambang, as he presented his dissertation, “The Infuence of Educational Intervention and the Circadian Cycle to the Safety of Fasting during Ramadan for Child and Teen Sufferers of Type 1 DM”.
Most Type 1 DM sufferers in Indonesia have bad metabolic control, and this may inhibit them from fasting. The chronic psychological stress that they suffer because of the disease may increase their cortisol stress hormone levels, which in turn increases blood sugar levels. Cortisol production has a characteristic morning-noon-night cycle (the Circadian cycle). What we don’t know yet is whether child and teen Type 1 DM sufferers undergo cycle changes in Ramadan similar to adults, which means that we don’t know yet whether any such change occurs and whether they may also suffer from acute complications because of fasting like adults as well.
dr. Bambang went on to explain that the study is meant to improve the safety of fasting during the Ramadan for child and teen Type 1 DM sufferers – by analyzing the roles of pre-Ramadan psychoeducation, metabolic control status, and changes in the cortisol circadian cycle respectively. The study was performed in two stages: first, the creation of pre-Ramadan psychoeducational modules, and the training of Type 1 DM facilitator and sufferers; second, the collection of data concerning complications through blood sugar checks and saliva tests for cortisol.