1959-P: First Real-World Evaluation of CGM Outcomes during Ramadan Intermittent Fasting in Type 2 Diabetes Using the SYAI Sensor

Introduction and Objective: Use of continuous glucose monitoring (CGM) systems during Ramadan fasting is increasing among people with type 2 diabetes (PWT2D). We evaluated changes in CGM metrics from pre- to during Ramadan and whether pre-Ramadan CGM metrics predicted fasting success among high-risk PWT2D who attempted to fast while using the SYAI CGM sensor. Methods: Pre-Ramadan and Ramadan CGM data were reviewed for 64 PWT2D using insulin and/or sulfonylurea (SU) who attempted to fast during Ramadan 2025. Eligible participants had two months of CGM data (pre- and during Ramadan) and sensor active time ≥70%. A composite “fasting double target” was defined as breaking the fast because of diabetes on ≤2 days and achieving Ramadan TIR >70%. Logistic regression was used to identify predictors of achieving the fasting double target Results: Glycemic control worsened from pre- to during Ramadan as follows: time in range (TIR) (67.68 to 62.38%, p<0.01); time above range (TAR>250) (8.57 to 11.18, p=0.01); Glycemia risk index (GRI) (32.82 to 39.49, p<0.01), and average glucose (165.85 to 173 mg/dl, p<0.01). No significant changes were noted in TBR, TAR>180, or coefficient of variation. Only 45% of PWT2D achieved the fasting double target. Participants who achieved the fasting double target had better pre-Ramadan CGM metrics than those who did not (TIR: 83.68 vs 54.58, p<0.01; GRI: 16.25 vs 46.39, p<0.01; average glucose: 141.63 vs 185.67, p<0.01; GMI: 6.72 vs 7.95, p<0.01; and TAR>180: 13.66 vs 32.48, p<0.01; and TAR>250: 1.62 vs 14.25, p<0.01). After adjusting for age, sex, employment/insurance status, educational level, age at diabetes diagnosis, and diabetes duration; pre-Ramadan TIR>70% and GRI ≤20 were strongly associated with achieving the fasting double target Conclusion: Among high-risk PWT2D using insulin and/or SU, glycemic control worsened during Ramadan fasting. Pre-Ramadan TIR and GRI were strongly associated with successful fasting, highlighting the importance of CGM-guided risk stratification and counseling before Ramadan Disclosure M.E. Al-Sofiani: Speaker's Bureau; Ended; Medtronic, Dexcom, Inc. Research Support; Current; Dexcom, Inc. Research Support; Ended; Medtronic. Speaker's Bureau; Ended; Insulet Corporation, Abbott Diabetes, Sanofi. H. Albalawi: None. S.K. Alharthi: None. F. Alam: None. A.S. Alangri: None. K.H. Aburisheh: None.