The FreeStyle Libre flash glucose monitoring system and the fasting month of Ramadan

The fasting month of Ramadan is a lunar month and Muslims abstain from eating, drinking, or using oral medications during this period. The duration of the fast starts before the beginning of dawn, ends at dusk and ranges between 12–19 hours. Management of diabetes during the fasting month of Ramadan can be challenging due to the amount and type of food consumption, physical activity, medications, and the duration of fasting. The main concern with fasting is the increased risk of hypoglycemia and hyperglycemia; therefore, capillary glucose monitoring is vital during Ramadan. The FreeStyle Libre (FSL) system (Abbott Diabetes Care, Alameda, CA, USA) is a unique interstitial system for monitoring glucose as it does not require user calibration. A patch sensor is fixed on the back of the upper arm and a hand reader is used to scan the sensor in order to receive the glucose readings. Several studies have shown that FSL is able to provide accurate glucose measurements when compared with capillary glucose blood results. The FSL results were not influenced by factors such as body mass index, age, type of diabetes, insulin administration, or hemoglobin A1c (HbA1c). The potential benefits of FSL were not tested during the months of Ramadan. Based on the safety and accuracy of FSL, further research is needed to assess the following: (I) whether the fast will have an impact on the accuracy of FSL; (II) how FSL can enable individuals with diabetes to complete the fast without encountering serious risks of hypoglycemia and hyperglycemia.