Twenty-Five Hours of Fasting with Automated Insulin Delivery in Youth with Type 1 Diabetes
Authors' conclusion
AID systems enable safe 25-h fasting by maintaining glucose control and reducing the risk of hypoglycemia and ketonuria. Fasting adjustments should be individualized and can often be minor.
Study context
- Population
- Adolescents and young adults with T1D using automated insulin delivery (AID) (mean age 17.3 ± 3.3 years, HbA1c 6.8 ± 1.0%); MiniMed 780 G, Control-IQ, open-source AIDMiniMed 780 G 34 · Control-IQ 10 · open-source AID 10
- Participants
- 54 adolescents
- Comparison
- 25-h Yom Kippur fast vs routine days, with AID
- Outcome
- TIR
Methodological detailsKetone levels measured after the 25-h fast and a routine overnight fast
- Ketone levels measured after the 25-h fast and a routine overnight fast
Main finding
As reported in the abstract
P < 0.01
Further findings
Time <70 mg/dL
- Time <70 mg/dL decreased from 2.6% to 2.2%
- P = 0.017
Hypoglycaemic events
- Mild hypoglycaemic events after the pre-fast meal
- 10
- Mild hypoglycaemic events during fasting
- 1
- Higher baseline % time <70 mg/dL was the only predictor of hypoglycaemia
780 G settings
- No significant difference between 780 G users with exercise mode and those with no or minor changes
Insulin received during fast, % of usual dose
- Insulin received, % of usual dose
- 43.4 ± 16.8% (range 9.3%-90%)
Ketone levels · end of 25-h fast vs regular morning
mmol/L
- Median (IQR) end-of-fast ketones
- 0.4 (0.3, 0.7)
- Median (IQR) ketones on a regular morning
- 0.1 (0, 0.1)
- Insulin doses <30% of usual dose were associated with higher ketone levels
- n = 31
Safety
- Mild hypoglycemic events after the pre-fast meal
- 10
- Mild hypoglycemic events during fasting
- 1
- Severe hypoglycemia or serious adverse events
- 0
Original publication
Twenty-Five Hours of Fasting with Automated Insulin Delivery in Youth with Type 1 Diabetes. Diabetes Technol Ther. Published 22 December 2025. doi:10.
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