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Disclosure: R.M. Alamoudi: None. A. Theyab: None. T. Shams: None. H. Alhashemi: None. Background: Pregnancy increases the risk of fasting hypoglycemia and is considered an exemption for fasting during Ramadan. Glucose patterns and hypoglycemia risk in relation to fasting Ramadan in pregnant women are not well studied. Objectives: To compare the risk of hypoglycemia, glucose patterns, and tolerance of fasting in pregnant women with gestational diabetes (GDM) versus women without GDM during fasting Ramadan. Methods: A prospective observational study conducted in the Obstetrics/Endocrine clinics at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Pregnant women without GDM, and with GDM managed by diet or metformin, who were planning on fasting Ramadan and were dedicated to applying a flash glucose monitoring (CGM) device for two weeks were recruited. Women with GDM received standard-of-care diabetes education regarding fasting during Ramadan. Participation was entirely voluntary. Results: 30 women with gestational age ≥ 24 weeks completed the study; 8 without GDM (Gp. 1), 16 with GDM on diet (Gp. 2), and 6 with GDM on metformin (Gp. 3). Mean demographics respectively: Age 30.13 ±4.9 vs. 33.56 ±6.4 vs. 34.50 ±5.8 (p=0.2), BMI 34.36 ±5.88 vs. 30.74 ±3.75 vs. 36.75 ±8.01 (p=0.4), Gravida 3 ±2.2 vs. 3.38 ± 2.48 vs. 4.33 ±2.88 (p=0.6). Breaking Ramadan fasting was reported in 13 (43%) of all participants; 3 (37.5%) vs. 6 (37.5%) vs. 4 (66.7%), respectively. The median (IQR) days fast broken were 2 vs 2 (4) vs 1 (11) days, p=0.2, with the reason being hypoglycemia in 1 vs 4 vs 2, and hyperglycemia in 0 vs 1 vs 2, the other reasons included fatigue and acute illness, p=0.3. The average hypoglycemia glucose reading in mg/dl (M± S.D) associated with breaking the fast was 56 ±4.8, p=0.54. The usual timing of hypoglycemia was late evening, while for hyperglycemia it was post-midnight meal followed by post-Suhoor (predawn meal). Ambulatory glucose profile (AGP) parameters per 450 patient days for the three groups respectively: Average glucose (mg/dl) (median - IQR) 89 (13) vs. 95 (24) vs. 103 (34), p=0.3, Time spent within range (BG 63-140 mg/dl) 87 (6)% vs. 81 (16)% vs. 80 (44) %, p=0.1, Glucose management indicator (M ±S.D) 5.4 ±0.2%, 5.6 ±0.4%, 5.5 ±0.3%, p=0.5, and Glucose variability 17.6 ±1.9%, 20.8 ±2.9%, 24.7 ±11.5%, p=0.07. Time spent above range (BG >140 mg/dl) 7 ±6% vs. 18 ±19% vs. 25 ±26%, p=0.2, Time spent below range (BG <63 mg/dl) 8 ±8% vs. 7 ±8% vs. 10 ±21%, p=0.8, and Duration spent in hypoglycemia (minutes) 90 ±117.4, 65.8 ±61.1, 70 ±108.03, p=0.8. CGM-detected hypoglycemic events (BG <63 mg/dl) were found in 20 (66.7%) of all participants, the average number of events (median-IQR) per group was: 4 (5) vs. 6 (8) vs. 1 (15), p=0.8. Conclusion: Pregnant women with non-insulin-treated GDM compared to those without GDM experienced similar difficulties in tolerating fasting during Ramadan and increased risk of hypoglycemia. The potential perinatal harm needs more research. ClinicalTrials.gov NCT04862390 Presentation: Saturday, June 17, 2023

Disclosure: R.M. Alamoudi: None. S.M. Nawar: None. H.S. Alharbi: None. A.A. Al Qarni: None. A. Alzahrani: None. A.K. Almulla: None. W.T. Busaad: None. N.F. Alahmari: None. N.D. Alshamrani: None. L. Alkhalifa: None. Y.M. Saleh: None. M. Ramadan: None. A. Borai: None. Background: The effect of Ramadan fasting on the thyroid profile, and the best time for L-thyroxine (LT4) intake in relation to fasting during Ramadan remains undetermined. Objectives: To compare two different time points of taking LT4 therapy during fasting the month of Ramadan in regards to thyroid profile and patient satisfaction. Methods: A multicenter open-label randomized controlled trial. Patients with primary hypothyroidism were recruited from three centers in three cities in Saudi Arabia (Jeddah, Riyadh, and Alhasa). Patients with thyroid cancer were excluded. TSH and FreeT4 (FT4) were measured two weeks before Ramadan, and four to six weeks after Ramadan. Results: 303 patients with primary hypothyroidism were randomized; 156 to take the LT4 dose at sunset with sips of water at the time of breaking fast and wait 30-60 minutes to eat the main Iftar meal (pre-Iftar), and 147 to take the LT4 dose just before the start of fasting (pre-dawn) regardless of their last meal intake. There were no significant differences between the two groups in demographics or comorbidities. The mean age was 49 ±12 years, 87% were female, and the average duration of hypothyroidism was 9.7 ±8.25 years. The mean weekly LT4 dose in the pre-Iftar vs. pre-dawn group was 753.3 ±349.4 vs. 733.2 ±265.6 mcg, p=0.001, and the Pre-Ramadan thyroid profile was: TSH 2.56 ±2.16 vs. 2.46 ±1.72 mIU/L, p=0.3, FT4 13.45 ±2.1 vs 13.08 ±2.4 pmol/L, p=0.16. Post-Ramadan thyroid profile values were: TSH 3.64 ± 4.1 vs. 4.07 ±4.17 mIU/L, p=0.78, FT4 12.96 ±0.1 vs. 12.64 ±0.22 pmol/L, p=0.003. The estimated difference within the group means post-Ramadan was - 0.41 ±0.51 mIU/L, p=0.43 for TSH, and 0.32 ±0.28 pmol/L, p=0.24 for FT4. Generalized linear model repeated measures analysis of variance showed no significant difference over time in TSH or FT4 within or between groups (p = 0.47 vs. 0.81). Patient compliance and satisfaction with the regimens were similar between groups. Conclusion: There is no significant change nor difference in thyroid profile between the two regimens related to the change in LT4 intake during the fasting months of Ramadan. Both regimens can be utilized depending on patient preferences. ClinicalTrials.gov: NCT05421468. Saudi FDA: SCTR # 22041002 Presentation: Friday, June 16, 2023

Background: Fasting Ramadan is practiced by Muslims globally. Compliance with health team advice on ability to fast or not, medication and lifestyle adjustments are the corner stone of achieving optimal diabetes control and avoiding complications with fasting. We aimed in this study to evaluate the attitudes and practice of Muslim patients with diabetes during fasting Ramadan, and to assess their compliance with the medical instructions provided by their healthcare team. Methods: A cross-sectional study conducted in four Medical Centers under the Ministry of National Guard health affairs in four cities: Al-Ahsa, Dammam, Jeddah and Riyadh. All patients with diabetes followed in the diabetes clinics within three months post Ramadan and who met the study inclusion and exclusion criteria were approached and consented for participation in the study, and then filled a self-administered validated 15 items questionnaire. Results: Data for 1438 diabetics were analyzed; 1207 (83.9%) T2DM and 231 (16.1%) T1DM. The mean age was 57.9 ± 14.9 years. 270 (18.8%) suffered multiple comorbidities. 559 (46.3%) of T2DM vs 22 (9.5%) of T1DM were not familiar with the type of their diabetes. 883 (73.2%) of T2DM were on combination therapy. There was a significant difference between T1DM and T2DM in health education received from the treating physician 168 (72.7%) vs 574 (47.6%) and from a dietician 165 (71.4%) vs 613 (50.8%) (p<0.0001), but education received from diabetes educators was not significantly different 189 (81.8%) vs 936 (77.6%) (p=0.15). Patients who followed diet advise were only 55 (23.8%) vs 43 (36.4%), respectively, (p=0.0002). 1191 (82.8%) reported fasting the full month, 162 (11.3%) were advised by their physicians to not fast. Patients who did not fast full Ramadan were 247 (17.2%), one third 92 (37.25%) of them based on physician advise with a compliance rate of (56.8%). Blood sugar was not well controlled before Ramadan and did not change significantly after Ramadan with a mean HbA1c (8.41 ± 2.0 and 8.40 ± 2.1) respectively, p-value 0.53. Multivariate analyses revealed that being on insulin, and prior hospitalization for diabetes were significant predictors of compliance with physicians advice related to fasting Ramadan [(OR 4.5, 95% CI, 1.7 - 12.2, p-value 0.003), (2.3, 95% CI, 1.2 - 5.1, p-value 0.048)] respectively, while lack of receiving education, type of diabetes, and degree of glycemic control did not predict compliance with statistical significance [(OR 1.9, 95% CI, 0.8 - 4.6, p-value 1.5), (1.06, 95% CI, 0.4 - 2.6, p-value 0.89), (1.3, 95% CI, 0.5 - 3.5, p-value 0.56)] respectively. Majority of patients were aware of a religious “Fatwa” on fasting with diabetes but their understanding of it varied. Conclusion: The study shows low level of patient awareness and compliance to health providers advice. Results indicate prior hospitalization and being on insulin treatment as predictors of patient compliance. This signifies the need for better structured diabetes and fasting education programs. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Background: Thyroid dysfunction in pregnancy is associated several adverse outcomes. This has triggered a debate about whether universal screening should be implemented. Despite recommendations against universal screening, the clinical practice of many caregivers may differ. We aimed to assess the sensitivity of using targeted high-risk case finding for diagnosing thyroid dysfunction in pregnancy compared to routine screening in pregnant Saudi women, and to evaluate if gestational diabetes (GDM) specifically affected the risk. Methods: A cross-sectional study in two hospitals under the Ministry of National Guards Health affairs of Saudi Arabia; King Abdulaziz Hospital, Al-Ahsa, and Imam Abdulrahman bin Faisal Hospital, Dammam. Pregnant ladies attending the Family medicine, Obstetrics and Gynecology, and Endocrinology clinics in both hospitals were assessed by the caring physician based on a check list for risk stratification for thyroid dysfunction as per the 2012 Endocrine society clinical practice guidelines for management of thyroid dysfunction in pregnancy. Presence of one risk factor defined high risk. All patients had a routine serum TSH measured as universal screening is commonly practiced in both institutions, the physician doing the risk stratification was not aware of the TSH result. Sensitivity and specificity for the case finding approach was calculated using and abnormal TSH value as the gold standard for presence of thyroid dysfunction. The institutions lab reference TSH 0.35 – 4.94 mIU/L was used as cutoff. Results: 1571 pregnant women were included in the study; mean age 29.3± 6.2 years, 396 (23.5%) were primigravida. The mean TSH value was 1.898 ± 1.459 mlU/L. 1178 (75%) pregnant women had an indication for screening based on presence of at least one risk factor, of which 95 (8.1%) tested abnormal for TSH. 393 women had no risk factors, of which 379 (96.4%) had normal TSH, (Chi square 9.3, p-value 0.002). [Sensitivity 87.2%, (95%CI 79.4% – 92.8%), Specificity 25.9%, (95%CI 23.7% – 28.3%)]. Total abnormal TSH values was 109 (6.9%), 43 were abnormal high (i.e. hypothyroid); of which 40 screened positive by case finding approach [Sensitivity 93.02%, (95%CI 80.9% – 98.5%), Specificity 25.52%, (95%CI 23.4% – 27.8%)]. Moreover, 178 (11.3%) women screened positive for GDM at some stage in pregnancy out of which only 5 (2.8%) had an abnormal TSH value, while of the 1393 pregnant women who screened negative for GDM 1289 (92.5%) had a normal TSH value, (Chi square 5.3, p-value 0.02). [Sensitivity 4.6%, (95%CI 1.5% – 10.4%), Specificity 88.2%, (95%CI 86.4% – 89.8%)]. Conclusion: Targeted high-risk case finding predicts thyroid dysfunction in pregnant Saudi women with high sensitivity supporting its utility in screening our pregnant population. Gestational diabetes is highly prevalent in Saudi women, but does not increase risk of thyroid dysfunction in pregnancy.

Background: For a whole month, every year Muslims fast daily from dawn to sunset. Those with health conditions that put them at risk are exempted from fasting, yet most of patients with diabetes choose to fast. Clinical and metabolic complications of diabetes during this month are issues of concern for patients and their managing physicians. This study is designed to evaluate the impact of fasting Ramadan on safety of patients. Methods: A multicentercross-sectional survey was conducted in four hospitals under the Ministry of National Guard Health Affairs; King Abdulaziz Hospital,Al-Ahsa, Imam Abdulrahman bin Faisal Hospital, Dammam, King Abdulaziz Medicalcities, Riyadh and Jeddah. All patients with diabetes followed in the diabetes clinics of all four centers who fulfilled the study inclusion and exclusion criteria were approached within three months post Ramadan and consented for participation in the survey, then filled a self-administered validated questionnaire that consisted of 15 items. Results: Socio-demographic,clinical, and laboratory characteristics of 1438 patients with diabetes were analyzed. The majority 1207 (83.9%) had type II diabetes, and 828 (57.6%) were females.The mean age was 57.9 ± 14.9 years, and mean BMI 25.25 ± 5.39.The majority 1060 (73.7%) had concomitant diseases. 36 (2.5%)were on diet therapy alone, 147 (10.2%) on metformin monotherapy, and 261 (18.2%) on insulin therapy alone. The remaining 994 (69.1%) were on combination of insulin and oral agents. Health education was received on average by 688 (57.8%) of patients. Out of the 1191 (82.8%) who fasted the full month, 497 (41.7%) experienced acute glycemic complications. Multivariate analyses revealed that significant predictors for unsafe fasting were: type I diabetes [OR 1.8 (95%CI 1.2 - 2.8), p-value 0.007], insulin therapy [OR 1.8 (95% CI 1.4 - 2.3), p-value0.0001], previous history of breaking fast for glycemic reasons [OR 2.1 (95% CI1.5 - 2.9), p-value 0.0001], and not receiving health education [OR 1.6 (95% CI1.2 - 2.0), p-value 0.0006]. Blood sugar control, presence of concomitant diseases, and history of diabetes related hospitalization were not statistically significant predictors [(OR 1.25, 95% CI, 0.9 - 1.7, p-value 0.15),(1.3, 95% CI, 0.9 - 1.8, p-value 0.14), (1.1, 95% CI, 0.8 - 1.6, p-value 0.45)] respectively. Conclusion: A significant proportion of patients with diabetes do not receive specific education pertinent to fasting Ramadan. Lack of health education, in addition to; type I diabetes, insulin therapy, and previous experience of complications are predictors for unsafe fasting. This highlights the need for better structured educational programs and further research in the field.

Background/Objectives: Obesity is a growing global health concern, which increases the risk of various diseases and has seen a rising prevalence over time. The global prevalence of obesity among adults has doubled over time. Obesity significantly impacts health by increasing the risk of a range of severe medical conditions. Cardiovascular diseases, such as heart attacks and strokes, are more prevalent in individuals with obesity due to factors like high blood pressure and abnormal cholesterol levels. This systematic review and meta-analysis sought to establish the effectiveness of bariatric surgery in treating infertility in women. Methods: This systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A broad electronic search was conducted through PubMed, Web Science, and Medline databases for studies published between April 2017 and October 2023. The search strategy used the following terms: bariatric surgery, metabolic surgery, bariatric surgical procedures, stomach stapling, infertility, and fertility issues. The data were analyzed using the Revman version 5.1.2 software. Results: The results of the study show that despite the heterogeneity found in the studies, irregular menstrual cycles were found to reduce significantly in patients who underwent bariatric surgery (p = 0.01), with an RR of 0.22, at a 95% CI (0.06, 0.74). With regards to infertility, the results indicate that bariatric surgery reduced the level of infertility among the patients significantly (p = 0.00001), with an RR of 0.55, at a 95% CI (0.45, 0.68). Further, the results show bariatric surgery reduced rate of miscarriages among patients (p = 0.01), with an RR of 0.51, at a 95% CI (0.30, 0.86). Moreover, bariatric surgery reduced the level of congenital malfunction, but the effect was not statistically significant (p = 0.16), with an RR of 0.39, at a 95% CI (0.10, 1.45). However, the overall effect of bariatric surgery on treating infertility was found to be significantly effective (p = 0.0001), with an RR of 0.54, at a 95% CI (0.43, 0.68). This implies that bariatric surgery helps in weight loss, which improves ovulatory dysfunction and irregular menstruation while boosting spontaneous conception. Conclusions: This study found that bariatric surgery helps infertile women of a reproductive age to lose weight, which improves ovulatory dysfunction and irregular menstruation while boosting spontaneous conception. On the other hand, the study noted that after bariatric surgery, spontaneous conception can occur because of a decreased rate of miscarriage, increased fertility, reduced levels of congenital malfunction, and the restoration of regular menstrual cycles. Therefore, this study highlights the need to offer adequate preconception care and counselling to women who are about to be pregnant, both before and after bariatric surgery. Further, based on the fact that this study focused on general bariatric surgery, future research should focus on specific types of bariatric surgery to establish the most effective type of bariatric surgery in treating infertility in women.