437 - Glycemic Emergencies in Pediatric Patients During Ramadan: A Retrospective Emergency Department Analysis

Publication Number: 4428.437

Julia Klein, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States; Kari Schneider, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States; Viviane Tchonang Leuche, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States; Iluonose Amoni, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States; Zujaja Sadiq, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States; Scott Lunos, University of Minnesota, Minneapolis, MN, United States; Jeffrey Louie, University of Minnesota, Minneapolis, MN, United States

Background: Pediatric emergency department (ED) visits fluctuate with seasonal patterns. Clinical staff at our urban children’s hospital serving a large Muslim population have observed that Ramadan may influence ED visit patterns. Ramadan is a month of fasting observed by Muslims worldwide, during which individuals abstain from food and drink from dawn to dusk. Although fasting is not required until puberty, children may begin participating at younger ages. This shift can significantly impact patients with diabetes. In adults, diurnal intermittent fasting is linked to hypoglycemia, especially in type 2 diabetes. However, data on the pediatric population remain limited.

Objective: This study evaluates the incidence of hypoglycemia or DKA among pediatric ED patients during Ramadan versus non-Ramadan periods.

Design/Methods: We conducted a retrospective chart review of patients (0–18 years) who presented to an urban children’s ED between 2019 and 2024 with hypoglycemia or DKA. Data included demographics, presenting symptoms, laboratory results, diagnosis, disposition, and religious affiliation. Muslim patients presenting during Ramadan were compared with non-Muslim patients during the same period. Descriptive statistics and Fisher’s exact tests were used to assess differences in hypoglycemia rates.

Results: A total of 233 ED visits (221 unique patients) were included. Patients had a mean age of 4.3 years (SD 4.5; range 0–17.8) with no substantial differences across groups. The sample included 51 Muslim patients (21.9%) and 182 non-Muslim patients (78.1%). The rate of hypoglycemia was higher among Muslim patients (84.3%) compared to non-Muslim patients (74.6%), though this was not statistically significant (Fisher’s exact test p=0.189). No significant differences were observed in hypoglycemia rates between Ramadan and non-Ramadan periods for Muslim (p=0.696) or non-Muslim patients (p=1.000). DKA occurred in 12 visits (5.2%), with similar rates across subgroups. No statistical tests were performed for the subgroup of patients aged 12 to 18 due to the small sample size of 19 unique patients.

Conclusion(s): In this retrospective ED-based study, Ramadan fasting was not associated with increased rates of hypoglycemia or DKA among Muslim pediatric patients. These findings suggest that observed glycemic emergencies during Ramadan were not more frequent than during non-Ramadan periods. Further studies, particularly those focused on adolescents, are needed to assess the safety of fasting and preventive strategies in youth with diabetes.