Evaluate diabetic patients' knowledge, practices, and the prevalence of complications during Ramadan fasting (RF) before and after an education program.

We conducted a prospective study including 140 consecutive diabetic patients (DP) who intended to observe RF in 2023. Patients underwent a questionnaire and received pre-Ramadan education (PRE) according to the IDF-DAR 2021 recommendations. Practices and outcomes (hypoglycemia, hyperglycemia, and cardiovascular events) of RF patients were determined during Ramadan 2022 and 2023 using a questionnaire.

Participants mean age was 56.0 ± 9.3 years. Their knowledge level was good, average, and poor in 37.1%, 35%, and 27.9% of cases, respectively. Before RF 2022, 40.9% of patients reported consulting their physicians about diabetes management during fasting and 12.1% received education. The risk stratification showed that 45.7% of patients were at low risk, 32.9% at moderate risk, and 21.4% at high risk. Compared to 2022 RF, significant changes in eating patterns and physical activity practice were observed in 2023. Self-monitoring blood glucose (SMBG) was practiced by 35.6% of patients in 2022 and 75% in 2023 (p < 0.001). The number of patients who fasted the whole month of Ramadan and hypoglycemia prevalence were comparable between 2022 and 2023. Hyperglycemia prevalence was higher in 2023 (14.9%) than in 2022 (3%) (p < 0.001). No severe hypoglycemia, cardiovascular events, or hospital admissions were observed during RF 2022 and 2023.

The majority of diabetic patients had poor to average knowledge about diabetes and fasting. They were categorized as moderate- to high-risk of complications during RF. PRE had a positive impact on lifestyle, dietary patterns, and SMBG practice. Although this education did not lead to a decrease in hypoglycemia or hyperglycemia events, no severe metabolic or cardiovascular complications were reported.

The Diabetes and Ramadan Risk Calculator, developed in 2021, is a pivotal tool for assessing fasting-related risks among patients with diabetes. This ground-breaking innovation offers a quantitative assessment of risk scores during fasting, revolutionizing the landscape of diabetes management during Ramadan. Many components assessed by the calculator are amenable to modification, presenting an opportunity for year-round intervention to mitigate risk scores and subsequent fasting risks. By targeting modifiable risk factors and adapting strategies over time, individuals with diabetes can proactively diminish their fasting-related risks, safeguarding their physical well-being and spiritual engagement and potentially improving their overall diabetes control. This review aims to elucidate the evolution of the strategies for addressing modifiable risk factors, reducing risk scores and levels, and ensuring safe fasting practices.

Background/Objectives: Mini-dose glucagon (MDG) is a safe and effective option for managing hypoglycemia during prolonged, repetitive fasts in people with type 1 diabetes (pwT1D) during Ramadan. We aimed in this study to evaluate the effectiveness and patient satisfaction of MDG for the management of fasting-induced hypoglycemia from the perspective of pwT1D fasting during Ramadan. Methods: We conducted an online survey shared via social media platforms and email announcements from May 2021 to April 2023 to collect feedback from 136 (72 female) persons with T1D about their experiences using MDG. In the survey, participants were asked to answer questions about diabetes history, hypoglycemia management during Ramadan, the efficacy of MDG treatment, the psychological impact of breaking the fast, side effects, injection experiences, and preferred future treatments for hypoglycemia caused by fasting. Results: After using MDG, 123 (91%) of participants reported they were able to complete their fasts. A total of 110 (80%) of participants reported that they prefer to use MDG over oral options in the future to correct fasting-induced hypoglycemia. Furthermore, participants showed significant change in their habits, which would otherwise have left them exposed to hypoglycemia or hyperglycemia for longer periods of time during fasts. Conclusions: These data demonstrate positive user experience and satisfaction following MDG as a treatment for fasting-induced hypoglycemia in pwT1D. Furthermore, MDG can promote the successful completion of fasts in Ramadan and encourage a change in unhealthy habits that may lead to prolonged hypoglycemia during fasts.

To assess the impact of Ramadan and pre-Ramadan diabetes education (PRE) on metabolic parameters in people with type 2 diabetes (T2D). Additionally, we described the proportion of Ramadan-related adverse events.

A retrospective longitudinal study utilising Dutch routine primary care data from 133 people with T2D who participated in a PRE session. Linear Generalized Estimating Equations models were used to assess the association of metabolic parameters with Ramadan and PRE. We analysed free-text notes and a questionnaire to identify Ramadan-related adverse events.

Ramadan was associated with modest reductions in HbA1c (β -1.07 mmol/mol; p = 0.07), systolic blood pressure (β -1.89 mmHg; p = 0.04), weight (β -0.81 kg; p < 0.01), BMI (β -0.29 kg/m2; p < 0.01), and a slight increase in triglycerides (β 0.27 mmol/l; p = 0.04) compared to non-Ramadan periods. PRE demonstrated no significant impact on metabolic parameters. The number of medical notes regarding Ramadan was small, with the mentioning of some physical complaints and medication errors.

In our study, Ramadan is associated with temporary and marginal metabolic improvements in people with T2D. A single PRE session had no substantial impact on metabolic control. Healthcare professionals should more often discuss Ramadan and medication adjustments with their patients.

This study aimed to assess the prevalence of glycemic fluctuations, fatigue, and sleep disturbances during Ramadan, and to identify factors associated with hypoglycemia and hyperglycemia events in this period.

A cross-sectional study of 88 individuals with type 2 diabetes during Ramadan fasting from (08/03/2024) until (20/04/2024) was conducted. HbA1c levels before Ramadan were obtained from medical records. Participants monitored blood glucose twice daily (during the day and two hours after breaking fast). Blood glucose under 70 mg/dl was considered hypoglycemia, and over 200 mg/dl was hyperglycemia. Fatigue was thoroughly assessed using the Indonesian Multidimensional Fatigue Inventory-20 (IMFI-20), while the Pittsburgh Sleep Quality Index (PSQI) was utilized to evaluate sleep quality. In addition, data on sleep duration, as well as dietary habits during Ramadan, were also collected.

A total of 88 patients with type 2 diabetes (mean age, 52.7 years) participated, predominantly female (68.2%) and married (63.6%). The study found a prevalence of 21.6% for hypoglycemia and 30.6% for hyperglycemia. Additionally, 30.7% of participants experienced fatigue, and 40.9% reported poor sleep quality. HbA1c levels before Ramadan and fatigue were significantly associated with both hypoglycemia and hyperglycemia (p <  0.05). Sleep quality was also significantly associated with hyperglycemia events (p <  0.05). Furthermore, sleep duration was significantly related to hyperglycemia events (p =  0.01). Meal timing, frequency, and dietary patterns during Ramadan were also found to be significantly associated with both hypoglycemia and hyperglycemia (both p <  0.05).

Hypoglycemia and hyperglycemia are common among people with type 2 diabetes during Ramadan. Fatigue and poor sleep quality were also widespread. Key factors linked to these glycemic fluctuations were pre-Ramadan HbA1c levels and fatigue, while sleep quality was particularly associated with hyperglycemia. These results highlight the need for personalized care to manage blood sugar levels and improve overall health during Ramadan. We recommend that healthcare providers advise patients with type 2 diabetes to aim for 7-8 hours of sleep per night to help control blood glucose levels. Additionally, having three meals a day (Suhoor, Iftar, and a post-Iftar snack) with low glycemic index foods can help maintain stable blood glucose and prevent both hypoglycemia and hyperglycemia during Ramadan.

Management of type 2 diabetes mellitus (T2DM) during Ramadan fasting presents unique challenges due to prolonged fasting periods, irregular meal schedules, and altered medication timing, potentially impacting glycemic control. Ertugliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, has been shown to improve glycemic control in T2DM effectively. However, the effectiveness of ertugliflozin during Ramadan fasting, a period with unique glycemic challenges, has not been studied extensively.

This study was a multicenter, real-life experience study involving 1373 adult patients with known T2DM for at least one year, an HbA1c level of less than 10%, and who intended to fast during Ramadan. Participants were divided into two groups: the Ertu group (n=703), consisting of patients who had been on a stable dose of ertugliflozin for at least three months before Ramadan, and the non-Ertu group (n=670), which included patients receiving other oral antihyperglycemic drugs (OADs) except ertugliflozin. Patients attended a baseline visit one month before the first day of Ramadan and a follow-up visit within one month after the last day of Ramadan. Both visits included history taking, physical examinations, and laboratory tests. The primary endpoints were changes in HbA1c levels, body weight, body mass index (BMI), and the incidence of hypoglycemia during Ramadan fasting.

The mean age of the study participants was 50.37 ± 11.14 (SD) years, with 40.6% male and 58.7% female. Patients receiving ertugliflozin showed significant reduction in HbA1C (-0.65 ± 0.67% vs. -0.22 ± 0.64%, p<0.001), body weight (-1.24 ± 2.58 kg vs. -0.36 ± 3.41 kg, p<0.001), and BMI (-0.48 ± 1.03 kg/m² vs. -0.11 ± 1.33 kg/m², p<0.001) compared to the non-Ertu group. Hypoglycemia was reported in 0.3% of the ertugliflozin group and 0.7% of the other group, with comparable adverse events (p=.23; ≥0.05), indicating a favorable safety profile for ertugliflozin during fasting.

This study demonstrates that ertugliflozin is effective and safe for patients with T2DM during Ramadan fasting.

Background The International Diabetes Federation-Diabetes and Ramadan (IDF-DAR) risk stratification tool is designed to predict adverse outcomes in patients with diabetes who fast during Ramadan. Objectives This study evaluates the accuracy of the IDF-DAR tool in predicting adverse outcomes among Saudi patients with diabetes intending to fast during Ramadan while comparing outcomes across different risk categories. Methods This prospective observational study was conducted at the Obesity, Endocrine, and Metabolism Center, King Fahad Medical City, and diabetes clinics at King Abdulaziz Medical City in Riyadh, Saudi Arabia. Data were collected through questionnaires on diabetes characteristics, complications, comorbidities, and factors influencing fasting. Ordinal regression analysis was performed to identify predictors of risk levels. Results The cohort consisted of 303 patients, including 163 females (53.5%) with a mean age of 50.49 ± 17.91 years. Type 2 diabetes mellitus was diagnosed in 217 participants (71.6%), and 231 patients (76.2%) had diabetes for over 10 years. Risk stratification categorized 39 patients (12.9%) as low risk, 71 (23.4%) as moderate risk, and 193 (63.7%) as high risk. Self-monitoring of blood glucose adherence was reported in 174 patients (57.4%), with the highest adherence in the high-risk group (126 or 65.3%) and the lowest in the low-risk group (18 or 46.2%). Hyperglycemia (>16.6 mmol/L) was observed in 141 participants (47%): 13 (33.3%) low risk, 26 (36.6%) moderate risk, and 103 (53.4%) high risk. Hypoglycemia was the most common reason for breaking the fast, notably among 23 patients (71.9%) fasting for more than 15 days. A significant majority of participants aimed to fast for the full 30 days, with the highest completion rate among moderate-risk individuals at 58 (81.7%). In contrast, 27 individuals (14.92%) in the high-risk group did not fast at all. Conclusions The IDF-DAR tool effectively stratifies fasting risk in diabetic patients but may not accurately reflect the risk for some high-risk individuals. Further validation is necessary to enhance its predictive accuracy.

Aims: The study was aimed at assessing the role of the MiniMed780G system of glycemic control before, during, and after Ramadan among people with Type 1 diabetes (PwT1D). Methods: This is a single-center retrospective analysis of MiniMed780G system users aged 14 years and above whose glycemic profiles were collected from February 21 to May 20, 2023, which corresponds to the Hijri months of Sha'ban, Ramadan, and Shawwal 1444/1445. Data was collected, processed, and analyzed in the framework of the Medtronic Galaxy service of the One Hospital Clinical Service (OHCS) program in Dallah Hospital, Riyadh, Saudi Arabia. Data from 43 PwT1D (24 females, mean age 30 ± 11 years with 14 ± 8 years from diabetes onset) using the MiniMed780G system were collected. Results: Overall, the 3-month (Sha'ban, Ramadan, and Shawwal) mean sensor glucose (SG), time in range (TIR) (70-180 mg/dL), time below range (TBR) (54-69 mg/dL and < 54 mg/dL), time above range (TAR) (180-250 mg/dL and > 250 mg/dL), and glucose management indicator (GMI) showed no statistical differences within the three periods. No differences in insulin total daily dose have been detected, and no diabetic ketoacidosis (DKA) or severe hypoglycemia events occurred. Conclusion: The use of the MiniMed780G system is safe with favorable glycemic outcomes across nonfasting and fasting months.

Community pharmacists are often the first point of contact for patients seeking assistance in managing chronic diseases, including diabetes, owing to their accessibility. They are readily available to patients, especially in outpatient settings, and can play a vital role in ensuring safe medication use in patients with diabetes. However, published research on the role of community pharmacists in managing diabetes in patients fasting during Ramadan in Türkiye and worldwide is limited.

The aim of this study was to investigate the perspectives and experiences of Turkish community pharmacists in providing treatment management for people with diabetes during Ramadan.

To obtain in-depth information about community pharmacists' experiences and perspectives regarding the treatment management of patients with diabetes during Ramadan, a qualitative methodology was chosen for data collection, which could not be obtained using quantitative methods. To gather the views of community pharmacists, a carefully designed semi-structured interview guide was developed to conduct the qualitative interviews. Following the transcription and translation processes, interpretive phenomenological analysis was conducted as an integral part of the data analysis.

A total of 21 pharmacists participated in this study. Three main themes, along with their corresponding subthemes, emerged from the dataset: Advice from pharmacists to patients, challenges, and recommendations. The study revealed the professional services pharmacists provided and the barriers they encountered, and documented the recommendations they put forward regarding diabetes treatment management.

Pharmacists reported providing diabetes-related services during Ramadan, such as dietary advice, medication adjustments, and dietitian referrals. However, they identified several significant challenges, including increased workload, patients' religious beliefs, and limited public awareness of their expertise. To address these, expanding pharmacists' roles, improving communication with patients and physicians, and incorporating Ramadan-specific diabetes management into pharmacy education are seen as key strategies for enhancing care.

Diabetic kidney disease populations are categorized as high risk for fasting in Ramadan due to various potential fasting-related complications. Insulin analogues are recommended to be used in place of human insulin during fasting, as they carry a lower risk of hypoglycaemia and stable glycaemic variability. A paucity of data exits on the safety and efficacy of different basal insulin types during fasting for this population. This study aims to evaluate the safety and efficacy of three basal insulin among patients with Type 2 Diabetes Mellitus and concomitant mild to moderate chronic kidney disease who are keen to fast during Ramadan.

A single-centered, prospective observational study was conducted among 46 patients with type 2 diabetes mellitus and concomitant chronic kidney disease stage 2 and 3 who were on three different types of basal insulin (Glargine U-100, Levemir, and Insulatard), fasted in Ramadan 2022. All variables were listed as median (IQR). Hypoglycaemia events and glycemic variability obtained from Freestyle Libre continuous glucose monitoring were compared between insulin groups. Changes in glycated haemoglobin, fasting plasma glucose, renal profile, body weight, body mass index, and waist circumference pre and post-Ramadan were evaluated.

The glycaemic variability was found highest in Insulatard with a median (IQR) of 37.2(33)% versus Levemir 34.4(32.4)% versus Glargine U-100 36.8(30.6)%, p = NS. Levemir had reported the lowest median time of below range of 2.5(13)% followed by Glargine 4(25)% and Insulatard 5(8)%; p = NS. The findings of this study indicated that glycated haemoglobin, fasting plasma glucose, renal profile, body weight, body mass index, and waist circumference did not alter statistically between the three groups post-Ramadan. Individually, Insulatard showed a significant reduction in weight and waist circumference (0.9kg, p = 0.026; 0.44 cm, p = 0.008) while Levemir showed a reduction in waist circumference (0.75cm, p = 0.019).

This study revealed that Insulatard, Levemir, and Glargine demonstrated similar levels of safety and efficacy among those with diabetic kidney disease who observed fasting during Ramadan.

In this study, we aimed to identify sleep patterns, physical fitness, and barriers to physical activity (PA) during Ramadan observance in a cohort of nonfasting individuals with type 1 diabetes (T1D).

Sixty-one nonfasting individuals with T1D, age 28.34±9.43 years (ranging from 15 to 54 years), completed questionnaires before and during Ramadan. The questionnaires included 3 assessment instruments: the Barriers to Physical Activity in Type 1 Diabetes (BAPAD1), the Pittsburgh Sleep Quality Index (PSQI), and the International Physical Activity Questionnaire.

During Ramadan, there was no significant change in BAPAD1 scores compared to before Ramadan (p=0.378). The primary barriers encompassed hypoglycemia risk, work schedules, diabetes control, and fatigue. Moreover, subjective sleep quality deteriorated during Ramadan compared to the pre-Ramadan period (p<0.001). Sleep duration decreased by 58 minutes (p<0.01) and was associated with later bedtimes and more awakenings. There was a notable decrease in PA levels (p=0.042), particularly for vigorous activities (p=0.017), whereas sedentary time showed a significant increase (p=0.008).

Ramadan observance did not affect barriers to PA in individuals with T1D despite alteration of sleep patterns and PA levels. Lifestyle alterations associated with Ramadan observance significantly impact individuals with T1D who are not fasting, resulting in reduced PA, shortened sleep duration, and increased sedentary time.

Managing glycemia during Ramadan is challenging for individuals with type 1 diabetes (T1D) due to prolonged fasting and altered eating patterns. While many are exempt from fasting, some choose to fast, necessitating careful monitoring. The glycemia risk index (GRI) is valuable for assessing glycemic quality and interpreting continuous glucose monitoring (CGM) data to identify individuals needing closer clinical attention. This study investigates the effects of Ramadan fasting on glycemic control in T1D, focusing on GRI and its components for hypoglycemia (CHypo) and hyperglycemia (CHyper).

An ambispective study involved 186 individuals with T1D using intermittent scanning CGM (isCGM). Data were retrospectively collected for one month before Ramadan and prospectively during and one month after Ramadan. Clinical, metabolic, and glycemic data were collected, with GRI calculated alongside its components.

During Ramadan, GRI improved by 54.6% (from 56.4 to 25.6), CHypo decreased by 60% (from 6 to 2.4), and CHyper dropped by 40.5% (from 21 to 12.5). However, these benefits were temporary, as glycemic measures increased after Ramadan, reflecting a return to pre-Ramadan patterns once normal routines resumed. No participants were admitted for diabetes emergencies during Ramadan. Adolescents and patients on insulin pumps had more favorable outcomes. GRI and its components significantly correlated with other CGM metrics, with these relationships maintained during and after Ramadan.

Ramadan fasting significantly improved GRI and its components in individuals with T1D. Incorporating GRI as a novel metric alongside classical CGM metrics could enhance glycemic control, highlighting the need for personalized diabetes management strategies.

In this study, death rates for a metropolitan city were analyzed over a period of 33 years to investigate any potential relationship between the month of Ramadan and death rates. The study also aimed to obtain seasonally adjusted results using time series analysis. Ultimately, the total evaluation of the 33-year period revealed no significant variation in death rates between Ramadan and non-Ramadan periods. Separate analyses for each season with time series also yielded no significant findings for most parameters, with the exception that the number of female deaths during Ramadan in winter was significantly higher than expected. According to these results, the increase in the number of deaths observed among women during the winter Ramadan period requires further investigation to determine whether a causal relationship exists. The use of seasonally adjusted approaches and time series analyses in future Ramadan and health studies is crucial for the accuracy of the results.

There is a large body of research on Ramadan intermittent fasting (RIF) and health in Muslim communities, that can offer insights to promote the achievement of Sustainable Development Goal 3 (SDG 3), which encompasses good health and well-being. Based on recent bibliometric evidence, we hypothesized that RIF research is highly relevant to SDG 3, particularly Targets 3.1, 3.2, 3.4, and 3.5. Therefore, this bibliometric study quantified RIF literature supporting SDG 3 and associated targets over the past seven decades and explored themes and trends. All types of research articles were extracted from the Scopus database from inception to March 2022. Microsoft Excel, Biblioshiny, and VOSviewer were used to qualitatively and quantitatively examine RIF research trends supporting SDG 3 and associated targets. We identified 1729 relevant articles. The number of publications notably increased since 1986, with a dramatic increase in 2019-2020. RIF research predominantly supported Target 3.4 (reducing risk for non-communicable diseases), with research hotspots being diabetes, diabetes medications, pregnancy, physiology, metabolic diseases, and obesity and metabolism. This target was also the most commonly supported by dedicated authors and institutions publishing on RIF, whereas other SDG 3 targets were negligibly addressed in comparison. Our comprehensive bibliometric analysis of RIF literature showed growing support for SDG 3 through positive contributions to half of the SDG 3 targets, although Target 3.4 received the most attention. We also identified knowledge gaps that may shape further research directions on RIF and promote the achievement of SDG 3 in Muslim communities.

Intermittent fasting (IF) regimens have emerged as a dietary tool to improve the glycemic profile, but a critical appraisal of clinical studies assessing the effects of IF regimens in patients with diabetes is needed. Thus, this review encompasses clinical studies examining the impact of different IF regimens on markers of glycemic control in patients with diabetes. Furthermore, clinical nuances relative to pharmacological treatment are also addressed, mainly insulin therapy, to discuss the risk of hypoglycemic events. Only a handful of clinical studies have investigated the effects of IF on patients with diabetes. Overall, IF regimens may elicit modest benefits on glycemic parameters in patients with diabetes, but their effects are not necessarily greater than those of control diets. Last, although IF regimens may be considered safe for patients receiving insulin therapy within interventional and observational research, markers of glycemic control must be constantly monitored in clinical practice to reduce the risk of hypoglycemia and its related complications.

The objectives of this study were to evaluate the stratification of people with diabetes mellitus (DM) based on the International Diabetes Federation-Diabetes and Ramadan 2021 risk calculator into different risk categories and assess their intentions to fast and outcomes of fasting during the holy month of Ramadan.

This was a 3-month prospective study that was performed from February 9, 2023, to May 6, 2023 (6 weeks before Ramadan until 6 weeks after Ramadan), at a tertiary care hospital in Pakistan. Data regarding glycemic control, characteristics and complications of diabetes, comorbidities, and the various factors that influence fasting were gathered from patients of either sex aged 18 to 80 years with any type of diabetes. The International Diabetes Federation-Diabetes and Ramadan 2021 risk calculation and recommendation were made accordingly for each patient.

This study comprised of 460 participants with DM, with 174 males (37.8%) and 286 females (62.2%). The risk categorization showed that 209 (45.4%), 107 (23.3%), and 144 (31.3%) of the participants were in the low-, moderate-, and high-risk categories, respectively. Of the 144 high-risk patients who fasted, 57.9% experienced hypoglycemia (P <.0001). The recommendation of fasting showed statistically significant differences with risk categories, intention to fast, hypoglycemia, type of DM, duration of DM, level of glycemic control, and days of fasting (P <.001).

A statistically significant number of participants in the high-risk group who fasted experienced complications. This reiterates the importance of rigorous adherence to the medical recommendations.

Intermittent fasting (IF) refers to periodic fasting routines, that caloric intake is minimized not by meal portion size reduction but by intermittently eliminating ingestion of one or several consecutive meals. IF can instigate comprehensive and multifaceted alterations in energy metabolism, these metabolic channels may aboundingly function as primordial mechanisms that interface with the immune system, instigating intricate immune transformations. This review delivers a comprehensive understanding of IF, paying particular attention to its influence on the immune system, thus seeking to bridge these two research domains. We explore how IF effects lipid metabolism, hormonal levels, circadian rhythm, autophagy, oxidative stress, gut microbiota, and intestinal barrier integrity, and conjecture about the mechanisms orchestrating the intersect between these factors and the immune system. Moreover, the review includes research findings on the implications of IF on the immune system and patients burdened with autoimmune diseases.

Managing diabetes during Ramadan fasting is a challenge due lifestyle changes. We described the characteristics and patterns of care for type 2 diabetes mellitus (T2DM) during Ramadan 2020 and 2022.

Our study included multinational Muslims with T2DM who were during routine consultation. We collected data on demographics, fasting characteristics, and complications. Descriptive statistics, chi-square test, and multiple testing were performed.

12,529 patients participated. Mean age was 55.2 ± 11.8 years; 52.4% were females. Mean diabetes duration was 9.9 ± 7.4 years; 27.7% were with HbA1c >9% (75 mmol/mol) and 70% had complications. Metformin was the most used medication followed by insulin. 85.1% fasted ≥1 day; fasting mean duration was 27.6 ± 5.6 days. Hypoglycemia occurred in 15.5% of whom 11.7% attended emergency department or were hospitalized; this was significantly associated with age and/or duration of diabetes. Hyperglycemia occurred in 14.9% of whom 6.1% attended emergency department or were hospitalized and was also associated with age or duration of diabetes. 74.2% performed SMBG during fasting. 59.2% were educated on Ramadan fasting, with 89.7% receiving it during routine consultation.

Ramadan fasting in T2DM is high. Multidisciplinary approach is required to mitigate complications. Our findings support current recommendations for safe fasting.

This study assessed glucometric changes in Type 2 diabetes mellitus (T2DM) patients before, during, and after Ramadan fasting using an intermittently scanned continuous glucose monitoring system (isCGMS).

This prospective comparative study included T2DM patients aged 30-70 years who were receiving nonintensive insulin in Riyadh, Saudi Arabia. In addition to the baseline characteristics, glycated hemoglobin (HbA1c) and ambulatory glucose profile (AGP)-derived metric data were collected at three specific points: pre-, during-, and post-Ramadan. Self-care activities during Ramadan were evaluated using the Diabetes Self-Management Questionnaire (DSMQ).

Overall, a total of 93 T2DM patients were enrolled in the study. Their mean age ±SD age was 47.9 ± 7.5 years, and 51.6 % of them were males. Compared with pre- and post-Ramadan, there was a significant decrease in HbA1c (p < 0.001 for both periods), average glucose level (p = 0.001 and p = 0.026, respectively), glucose variability (p = 0.043 and p = 0.005, respectively), and % time above the range of 181-250 mg/dL (p < 0.001 for both periods), as well as a significant increase in % time in target (70-180 mg/dL) during Ramadan (p < 0.001 for both periods). However, the % time below 54 mg/dL was slightly greater during Ramadan than both pre- and post-Ramadan (p < 0.001 and p = 0.002, respectively). Furthermore, 32.3 % reported inadequate self-care behaviors during Ramadan.

Ramadan fasting could improve glucose levels in T2DM patients who were not on intensive insulin, with a relatively low incidence of hypoglycemia.

Intermittent religious fasting increases the risk of hypo- and hyperglycemia in individuals with diabetes, but its impact on those without diabetes has been poorly investigated. The aim of this preliminary study was to examine the effects of religious Bahá'í fasting (BF) on glycemic control and variability and compare these effects with time-restricted eating (TRE). In a three-arm randomized controlled trial, 16 subjects without diabetes were assigned to a BF, TRE, or control group. Continuous glucose monitoring and food intake documentation were conducted before and during the 19 days of the intervention, and the 24 h mean glucose and glycemic variability indices were assessed. The BF and TRE groups, but not the control group, markedly reduced the daily eating window while maintaining macronutrient composition. Only the BF group decreased caloric intake (-677.8 ± 357.6 kcal, p = 0.013), body weight (-1.92 ± 0.95 kg, p = 0.011), and BMI (-0.65 ± 0.28 kg, p = 0.006). Higher maximum glucose values were observed during BF in the within-group (+1.41 ± 1.04, p = 0.039) and between-group comparisons (BF vs. control: p = 0.010; TRE vs. BF: p = 0.022). However, there were no alterations of the 24 h mean glucose, intra- and inter-day glycemic variability indices in any group. The proportions of time above and below the range (70-180 mg/dL) remained unchanged. BF and TRE do not exhibit negative effects on glycemic control and variability in subjects without diabetes.

No data are available regarding glycemic management of individuals with type 1 diabetes (T1D) during Passover. Our aim in this study was to assess the effect of Passover on diabetes management and glycemic management in adults with T1D with nutritional changes during Passover (observant) compared with those who did not change their dietary habits during Passover (nonobservant).

We conducted an observational pre-post study of adults with T1D, followed in a diabetes clinic in Israel. Data were downloaded from insulin pumps and continuous glucose monitoring for 37 days: 2 weeks before Passover, 9 days of Passover, and 2 weeks thereafter. Differences in percentage of time spent above target (>10.0 to >13.9 mmol/L), at target (3.9 to 10.0 mmol/L), and below target (<3.9 to <3.0 mmol/L) were compared using paired t tests or paired signed rank tests.

The study cohort included 43 individuals with T1D (23 observant, 20 nonobservant). The average blood glucose was significantly higher during Passover compared with the period before Passover---in nonobservant patients 8.2±1.5 mmol/L and 7.9±1.3 mmol/L (p=0.043), respectively, and in observant patients 8.7±1.6 mmol/L and 8.4±1.6 mmol/L (p=0.048), respectively. Time above range 10 to 13.9 mmol/L was increased in observant individuals during Passover, as compared with the period before Passover, at 24.9±16.2% and 20.6±12.4% (p=0.04), respectively. The dose of bolus insulin had increased significantly in observant individuals: 27.4±13.9 units during Passover, as compared with 24.2±11.2 units before Passover (p=0.02).

Passover alters glycemic management and insulin needs in Jewish adults with T1D. It is advisable to make specific adjustments to maintain the recommended glycemic management.

Food deprivation can occur for different reasons. Fasting (<24 h duration) occurs to meet religious or well-being goals. Starvation (>1-day duration) occurs when there is intentional (hunger strike or treatment of a medical condition) or unintentional (anorexia nervosa, drought, epidemic famine, war, or natural disaster) food deprivation. A scoping review was undertaken using the PubMed database to explore 1805 abstracts and review 88 eligible full-text articles to explore the adaptive relationships that emerge between cortisol, insulin, glucagon, and thyroid hormones on the metabolic pathways of macronutrients in humans during fasting and starvation. The collected data indicate that fasting and starvation prime the human body to increase cortisol levels and decrease the insulin/glucagon ratio and triiodothyronine (T3) levels. During fasting, increased levels of cortisol and a decreased insulin/glucagon ratio enhance glycogenolysis and reduce the peripheral uptake of glucose and glycogenesis, whereas decreased T3 levels potentially reduce glycogenolysis. During starvation, increased levels of cortisol and a decreased insulin/glucagon ratio enhance lipolysis, proteolysis, fatty acid and amino acid oxidation, ketogenesis, and ureagenesis, and decreased T3 levels reduce thermogenesis. We present a potential crosstalk between T3 and the above hormones, including between T3 and leptin, to extend their adaptive roles in the metabolism of endogenous macronutrients during food deprivation.

Studies have shown that fasting during Ramadan has different effects on circulating levels of several biochemical markers. This study aims to conduct a comprehensive evaluation of studies related to the effect of fasting in the holy month of Ramadan on lipid profile, uric acid, and HbA1c in CKD patients. Studies were systematically searched and collected from three databases (PubMed, Scopus, and Web of Science). After screening, the quality and risk of bias assessment of the selected articles were evaluated. Study heterogeneity was assessed using the Cochrane test and I² statistic. In case of any heterogeneity random effects model with the inverse-variance method was applied. All analyses were performed using STATA software version 16. Four observational studies were included in this study. The results of this meta-analysis were that cholesterol (Weighted mean differences (WMD):0.21 with 95% CI:-0.09-0.51 (P-value=:0.18)), LDL (WMD:0.06 with 95% CI -0.24-0.36 (P-value:0.69)), triglyceride (WMD:0.05 with 95% CI:-0.25-0.35 (P-value:0.73)) had not-significant increase. Uric acid (WMD: -0.11 with 95% CI: -0.42-0.21 (P-value:0.51)) and HbA1c (WMD: -0.22 with 95% CI: -0.79-0.36 (P-value: 0.46)) show a non-significant decrease. The results of the analyses did not report significant changes in the lipid profile, uric acid, and HbA1c in CKD patients after Ramadan fasting.

There is a high prevalence of diabetes mellitus among Muslim adult patients. Those Muslims are required to fast the holy month of Ramadan. However, the Islam religion exempted some people with medical issues. It was not clear if all the patients with diabetes were considered medically unfit to fast Ramadan. Therefore, IDF-DAR group created a new risk calculator to categorize the patients with diabetes to advise with or against fasting accordingly.

This study is validating the IDF-DAR tool in assessing the accuracy of IDF-DAR risk calculator tool on adult patients with diabetes visiting primary health care in the Kingdom of Bahrain. The study will facilitate the health care professionals' decision to exempt the patients from fasting.

It is a prospective, randomized study for Ramadan 1444/2023 to assess the new IDF-DAR risk score tool that predicts the complications and the negative outcome of fasting during Ramadan. It included pre- and post-Ramadan questionnaires. 757 patients were selected randomly from the patients list of the central diabetes clinics in primary health care for pre-Ramadan risk assessment scoring. Post-Ramadan a phone a questionnaire was done to evaluate the ability of fasting and the occurrence of adverse events.

Out of the 757 participants, 611 were included in the study. The mean age of the studied population was 59.8 years and 52.8 % of them were female. 630 (95.3 %) had type 2 diabetes. According to the new IDF-DAR risk calculator, 184 (27.8 %) were categorized as low risk (≤3 score), 252 (38.1 %) as moderate risk (3-6 score), and 225 (34 %) as high risk (>6 score). The percentage of patients completed their 30 days fasting successfully without reporting adverse events in the low, moderate, and high-risk groups were 92.4 %, 89.3 %, 74.7 % respectively. There was significant increased risk in breaking the fast between the low-risk group and high-risk group with a p-value of <0.001. Similarly, there was significant increased risk in breaking the fast between the moderate-risk group and high-risk group with p-value of <0.001. The main reason of breaking the fast was hypoglycemic attacks. The leading factors that play a significant role in increasing the risk of adverse events during fasting Ramadan were type 1 diabetes mellitus, the presence of previous hypoglycemia attacks, the presence of renal impairment, and negative previous Ramadan experience.

The new IDF-DAR risk calculator is a good tool to predict both the ability to fast Ramadan and the probability of experiencing adverse events (mainly hypoglycemia) in people with diabetes mellitus in Kingdom of Bahrain.

To compare the fasting experience and glycemic control during Ramadan among people with type 1 diabetes (PWT1D) who use automated insulin delivery (AID) versus other modalities of treatment.

A total of 294 PWT1D who attempted fasting during Ramadan in 2022 were categorized on the basis of treatment modality into one of five groups: 1) AID (n = 62); 2) conventional pump + continuous glucose monitoring (CGM; n = 37); 3) pump + self-monitoring of blood glucose (SMBG; n = 8); 4) multiple daily injections (MDI) + CGM (n = 155); and 5) MDI + SMBG (n = 32). Predictors of fasting most days of Ramadan (i.e., breaking fast ≤2 days because of diabetes) were analyzed using uni- and multivariable logistic regression.

The median numbers of days when fasting was broken because of diabetes were 2, 5, 3, 3.5, and 2.5 for AID, conventional pump + CGM, MDI + CGM, pump + SMBG, and MDI + SMBG users, respectively (P = 0.047). Users of AID had a significantly greater time in range (TIR) and lower glycemia risk index, time below range, and time above range compared with users of conventional pumps and MDI (both P < 0.05). Likewise, 53% of AID users attained the double target of 1) breaking fast ≤2 days because of diabetes and 2) maintaining TIR ≥70% during Ramadan compared with only 3% of the conventional pump users and 44% of the MDI + CGM users (both P < 0.05). Compared with MDI + CGM users, AID users were twice as likely to complete fasting most days of Ramadan.

Use of AID is associated with the highest rates of fasting and best glycemic control during Ramadan fasting.

This review evaluates the current evidence on the safety and efficacy of sodium-glucose cotransporter 2 (SGLT2) inhibitors for patients with type 2 diabetes mellitus (T2DM) fasting during Ramadan. All studies included in the review were conducted in Asia and the Middle East. Overall, the evidence suggests that SGLT2 inhibitors are a safe and effective treatment option for most T2DM patients fasting during Ramadan. The average incidence of symptomatic hypoglycemia is 12.5%, but ranges from 0.7% to 27%, depending on the study population and concomitant use of other medications. The risk of hypoglycemia is increased when SGLT2 inhibitors are used in combination with insulin and/or sulfonylureas. Therefore, patients taking SGLT2 inhibitors in combination with insulin and/or sulfonylureas can take steps to mitigate this risk, such as having their insulin and/or sulfonylurea doses adjusted and being closely monitored for hypoglycemia. Patients taking SGLT2 inhibitors may be at increased risk of dehydration. To mitigate the risk of dehydration, patients should be advised to consume adequate fluids during the fast-breaking hours. Further research is warranted to validate these findings and extend their applicability to high-risk populations and other regions of the world.

To report on the effectiveness and safety of the MiniMed 780G automated insulin delivery system in real-world users during the month of Ramadan.

CareLink Personal data were extracted from MiniMed 780G system users from the Gulf region. Users were included if they had ≥10 days of sensor glucose data during the month of Ramadan 2022 as well as in the month before and after. For the main analysis, continuous glucose monitoring endpoints were aggregated per month and were reported by time of day (daytime: 05.31-18.00 h, and night-time). Additional analyses were performed to study the pace at which the algorithm adapts.

Glycaemic control was well kept in the 449 included users (mean sensor glucose = 152.6 ± 18.7 mg/dl, glucose management indicator = 7.0 ± 0.4%, time in range = 70.7 ± 11.0%, time below 70 mg/dl = 2.3 ± 2.3%). Albeit some metrics differed from the month before (p < .0001 for all), absolute differences were very small and considered clinically irrelevant. During Ramadan, there was no increased risk of hypoglycaemia during daytime (time below 70 mg/dl = 2.3 ± 2.4%), time in range was highest during daytime (80.0 ± 10.7%, night: 60.4 ± 15.3%), while time above 180 mg/dl was highest during night-time (37.3 ± 16.3%, day: 17.7 ± 10.7%). The algorithm adapted immediately upon lifestyle change.

The MiniMed 780G automated insulin delivery system is effective, safe and fast in adapting to the substantial changes that occur in the lifestyle of people with type 1 diabetes during Ramadan.

Muslims practice fasting during the ''holy month of Ramadan'', which poses special difficulties for those who have diabetes. Studies show that a sizable fraction of people with type 1 and type 2 diabetes fast despite the health hazards that come with the condition. This indicates that the incidence of diabetes among Muslims who fast is noteworthy. An increased vulnerability to acute problems, such as hypoglycemia, hyperglycemia, and diabetic ketoacidosis, is caused by extended fasting periods, irregular eating and sleeping routines, and changes in medication regimens. Healthcare professionals (HCPs), especially General Practitioners (GPs), should be involved in advising patients on safe fasting practices to strike a balance between religious observance and medical guidance. While guidelines from groups such as the Diabetes and Ramadan International Alliance and the International Diabetes Federation provide helpful suggestions, GPs are responsible for ensuring patient safety during Ramadan, particularly in areas where access to diabetes specialists is restricted. GPs are essential in managing diabetes-related issues before and throughout Ramadan, as well as in providing organized education and increasing awareness. A GP's primary responsibility at this time is to oversee the timely referral of high-risk patients and to effectively communicate with patients. To increase public awareness and support for diabetes care during Ramadan, it is also advised to work with religious leaders and make use of social media channels. It is ultimately in line with medical and religious beliefs to prioritize diabetes treatment during Ramadan, emphasizing the critical role general practitioners play in preserving the health and well-being of diabetics who are fasting.

Although it is known that religion is used to cope with health problems, there is a lack of information about the effect of religion on menopausal symptoms and cancer screening attitudes of climacteric women.

This study was conducted to determine the relationship between the religious attitudes of women in the climacteric period and their attitudes toward menopausal symptoms and cancer screening.

This was a cross-sectional study of 381 women in the climacteric period in the Central Anatolia region of Türkiye. Data collection form, the Menopause Rating Scale (MRS), OK-Religious Attitude Scale (ORAS), and attitude for cancer screening (short form) (ASCS) were used to collect data. Correlation analysis assessed the relationship between MRS, ORAS, and ASCS.

There was a low positive correlation between women's ORAS mean score (35.19 ± 4.80) and MRS mean score (12.68 ± 7.24) (r = 0.284, P < 0.001). There was no statistically significant relationship between the mean ORAS scores of the women and the mean ASCS scores (64.59 ± 10.47) (r = 0.089, P > 0.05).

Women who experienced more severe menopausal symptoms had stronger religious attitudes. Women's religious attitudes did not affect their attitudes toward cancer screening. It is therefore recommended that health professionals organize counseling and training activities to protect and improve the health of menopausal women and increase their participation in screening and treatment programs.

Diabetes is prevalent in Saudi Arabia. As dietary concerns are central in patients with diabetes, the impact of fasting on health during Ramadan is potentially significant. Decreased meal frequency and changes in food type and amount affect body weight and metabolic profiles. This study aimed to investigate the association between Ramadan fasting and anthropometric measurements and cardiometabolic and inflammatory biomarkers in Saudi adults with diabetes.

Sixty-eight Saudi adults with diabetes, admitted at the University Diabetes Centre in Riyadh, Saudi Arabia, were enrolled in this study. Participants were evaluated at the following time points: Six weeks before Ramadan (pre-fasting) and at least 15 days after the initiation of Ramadan (peri-fasting). Anthropometric measurements and cardiometabolic and inflammatory biomarker levels were assessed during both visits.

After accounting for confounding factors, Ramadan fasting was found to be associated with reduced body weight (kg), waist circumference (cm), and hip circumference (cm). Increased log high-density lipoprotein-cholesterol and decreased log interleukin 6 and C-reactive protein levels were observed.

Ramadan fasting was associated with increased HDL-C levels and decreased anthropometric measurements and inflammatory cytokine levels. These results support the beneficial role of Ramadan fasting in reducing cardiometabolic abnormalities and inflammation in adults with diabetes.

Ramadan fasting, a religious practice observed by Muslims worldwide, involves abstaining from eating, drinking, smoking, and using oral medications from dawn to dusk during the ninth lunar month. Studies have demonstrated that fasting during Ramadan has been shown to increase HDL cholesterol, leptin, adiponectin, and insulin sensitivity, as well as lower several hemostatic risk factors for cardiovascular diseases. Additionally, it may result in a drop in blood sugar levels, especially in diabetics who are also on blood sugar-lowering medicine. Hypoglycemia, characterized by low blood sugar levels, could also result from fasting during Ramadan. The GLP-1 (glucagon-like peptide-1) hormone plays a significant role in regulating glucose metabolism and insulin secretion, and Ramadan fasting can affect its production and release in the gut. Research contributes to our understanding of the utilization of GL-1 medications during Ramadan among patients, broadening therapy alternatives and offering insightful information for well-informed decision-making. Therefore, this narrative review aims to explore the current evidence that studies the safety and efficacy of GLP-1 agonists during Ramadan for nondiabetic and diabetic patients to ensure healthy fasting during Ramadan.

Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia.

To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment.

Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution.

Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.003) without increasing hypoglycemia. A significant reduction was observed in automated daily correction boluses and total bolus dose by 23.9% and 16.3% (p = 0.015 and p < 0.023, respectively) with less aggressive ICR settings within intervention group at end of Ramadan. Coefficient of variation was improved from 37.0 ± 9.4% to 31.8 ± 7.1%; p = 0.035). No severe hypoglycemia or diabetic ketoacidosis were reported.

Adjunctive vildagliptin treatment mitigated postprandial hyperglycemia compared with pre-meal bolus alone. Vildagliptin significantly increased TIR while reducing glycemic variability without compromising safety. Trial registration This trial was registered under ClinicalTrials.gov Identifier no. NCT06021119.

This study aims to reveal the feelings, difficulties, attitudes, and spiritual coping status of Turkish patients with Type 2 diabetes mellitus toward fasting during Ramadan. The sample of this descriptive qualitative study consists of 14 patients diagnosed with Type 2 diabetes. We determined two main themes and relevant sub-themes. The first was "the feelings and difficulties experienced due to diabetes mellitus" with the sub-themes of "negative emotions" and "difficulties in fasting." The second theme was identified as "religious and spiritual coping" with the sub-themes of "believing the disease comes from God," "having difficulty in adhering to disease-specific practices while fasting," and "feeling that fasting facilitates coping and provides relief." In conclusion, it was determined that the patients continued to fast despite the difficulties and that fasting facilitated coping and provided relaxation.

Mankind continues to suffer from the ever-growing diabetes epidemic and the rapid rise of type 2 diabetes mellitus (T2DM). This metabolic disease has been studied since ancient civilizations. The Arabo-Islamic civilization excelled in establishing some of the most notable discoveries and teachings that remained the blueprint for years to come in the field of diabetology.

This article aimed to review the ancient history of diabetes mellitus, with its main focus on the Arabo-Islamic civilization, and to report our subjective views and analysis of some of the past recommendations based on modern-day findings. Discussion. It is natural to have the teachings of medicine dynamically inspired by one civilization to another, as various fields continue to expand and evolve. This also applies to diabetology as the Arabo-Islamic world used the outlines of prior civilizations to revolutionize the understanding of the disease. Al-Razi and Ibn Sina are probably two of the most renowned polymaths in history, and their contributions to diabetology are well documented. Ibn Maymun's postulation about the higher prevalence of diabetes in Egypt as compared to Andalusia is something to be carefully studied. It could be that diabetes mellitus' underdiagnosis and late-stage detection are some of the major reasons for the disparity between the two mentioned regions. Modern-day Arabo-Islamic scholars continue to excel in revolutionizing diabetology.

The Arabo-Islamic world houses an impressive bout of scholars who have contributed since the ancient times to diabetology. This scientific locomotion shows no signs of stopping, as it continues to shine during the present day, and likely in the future.

The level of fasting blood glucose (FBG) is influenced by several factors, including health status, genetics, and diet. Some studies have reported a beneficial effect of Ramadan Intermittent Fasting (RIF) on diabetic patients. However, clinical observations have shown that diabetes is exacerbated in some patients.

This study aims to investigate the influence of RIF on the FBG level, a biomarker of hyperglycemia and diabetes, and to identify factors associated with variations in FBG levels during RIF among diabetic patients.

This study is a cross-sectional study. We monitored the FBG levels of 181 type II diabetic patients over a two-month period, from 20 February to 20 April 2023, which represents the Islamic lunar months of Shaban (8th month) and Ramadan (9th month). Ramadan provides a prominent month of intermittent fasting practice for studying its physiological effects on diabetes. We collected clinical data from each participant, including demographic information, co-morbidities, and medications used during this period.

Based on our findings, diabetic patients were classified into three groups depending on the influence of RIF on FBG levels: the positively affected group (44%), whose average FBG levels were reduced; the neutrally affected group (24%), whose average FBG levels did not change; and the negatively affected group (32%), whose average FBG levels increased during the fasting month of Ramadan compared to the previous month. Furthermore, we found that the positive effect of RIF was more frequent among obese, non-geriatric, and male diabetic patients, while the negative effect of RIF was more frequent among patients who were not adhering to the medication.

This study concludes that RIF affects FBG levels differently among diabetic patients. These findings should be taken into consideration when treating diabetic patients during the fasting month of Ramadan, and further studies are needed to identify (1) factors associated with inter-individual variation in the response to RIF and (2) those who are great candidates for RIF.

Pregnant women with diabetes are strongly advised against Ramadan fasting and have religious exemption, but a large proportion still choose to fast. Unfortunately, there is little information about glycemic control in these patients. This study aims to determine the fasting and postprandial blood glucose levels and to predict the risk factors for hypoglycemia in pregnant women with type 2 diabetes mellitus (DM) and gestational DM (GDM) who fast during Ramadan.

A prospective cohort research was conducted at a single tertiary hospital between 2021 and 2023 on 70 pregnant women with GDM (n = 53) and type 2 DM (n = 17) in their second and third trimester. Their fasting and postprandial blood glucose levels during Ramadan were compared to those of the previous month, and hypoglycemia was defined as blood glucose levels less than 60 mg/dl. Binary regression was used to predict the risk variables for hypoglycemia.

The GDM and type 2 DM groups were similar in terms of age, parity, number of fasting days, and number of daily fasting hours. Only 26.9% of the women who were permitted to fast were given special instructions for Ramadan fasting. Dietary intervention was more common in the GDM group, whereas insulin and metformin treatment were more common in the type 2 DM group. The fasting glucose level decreased significantly after Ramadan fasting in both groups, from 92.5 (17.4) mg/dl to 90 (17.13) mg/dl (p = 0.033). However, there were a significantly higher number of hypoglycemia events in the type 2 DM group. Further, type 2 DM was identified as a risk factor for hypoglycemia (OR = 6.23; 95% CI = 1.04-37.54; P = 0.046.

The present findings indicate that Ramadan fasting may improve fasting glucose control. In addition, type 2 DM was identified as a risk factor for hypoglycemia.

Fasting during the month of Ramadan is one of the five fundamental principles of Islam, and it is obligatory for healthy Muslim adults and adolescents. During the fasting month, Muslims usually have two meals a day, suhur (before dawn) and iftar (after dusk). However, diabetic patients may face difficulties when fasting, so it is important for medical staff to educate them on safe fasting practices. Prolonged strict fasting can increase the risk of hypoglycemia and diabetic ketoacidosis, but with proper knowledge, careful planning, and medication adjustment, diabetic Muslim patients can fast during Ramadan. For this review, a literature search was conducted using PubMed and Google Scholar until May 2023. Articles other than the English language were excluded. Current strategies for managing blood sugar levels during Ramadan include a combination of patient education on nutrition, regular monitoring of blood glucose, medications, and insulin therapy. Insulin therapy can be continued during fasting if properly titrated to the patients' needs, and finger prick blood sugar levels should be assessed regularly. If certain symptoms such as hypoglycemia, hyperglycemia, dehydration, or acute illness occur, or blood glucose levels become too high (> 300 mg/dL) or too low (< 70 mg/dL), the fast should be broken. New insulin formulations such as pegylated insulin and medications like tirzepatide, a dual agonist of gastric-inhibitory peptideand glucagonlike-peptide 1 receptors, have shown promise in managing blood sugar levels during Ramadan. Non-insulin-dependent medications like sodium-glucose-cotransporter-2 inhibitors, including the Food and Drug Administration-approved ertugliflozin, are also being used to provide additional cardiovascular benefits in patients with type 2 diabetes.

Hybrid closed-loop (HCL) systems have revolutionized the treatment of diabetes, enabling doctors to cope with challenging conditions that were previously almost impossible to manage or were very risky and difficult.

To assess the efficacy and safety of a hybrid closed-loop (HCL) system during Ramadan fasting in a pediatric cohort with type 1 diabetes (T1D).

Glucose control outcomes in older children and adolescents aged 8-16 years with automated insulin delivery for T1D were analyzed during Ramadan and 1 month before Ramadan. Participants on MiniMed standard HCL (670G) or advanced HCL (780G) systems of Medtronic were categorized as fasting or nonfasting.

The average age of the 19 participants (8 and 11 were on standard and advanced HCL systems, respectively) was 11.35 ± 2 years. Eleven patients fasted during Ramadan. Pump setup and sensor statistics were the same during Ramadan and the month before; no significant difference was found between the two groups in terms of insulin and glucose control metrics, with practically the same coefficient of variation, time in range (TIR) and time spent in hypoglycemia, maintained within the international recommended targets. Total daily doses were paradoxically higher in patients who fasted during Ramadan (p = 0.01), without repercussions on glucose control metrics.

Standard and advanced HCL use during Ramadan were safe and were associated with a maintained optimum TIR (>70 %) and no significant hypoglycemia in adolescents and older children with T1D.

Over the last decade, studies suggested that dietary behavior modification, including fasting, can improve metabolic and cardiovascular markers as well as body composition. Given the increasing prevalence of people with type 1 (T1DM) and type 2 diabetes mellitus (T2DM) and the increasing obesity (also in combination with diabetes), nutritional therapies are gaining importance, besides pharmaceutical interventions. Fasting has demonstrated beneficial effects for both healthy individuals and those with metabolic diseases, leading to increased research interest in its impact on glycemia and associated short- and long-term complications. Therefore, this review aimed to investigate whether fasting can be used safely and effectively in addition to medications to support the therapy in T1DM and T2DM. A literature search on fasting and its interaction with diabetes was conducted via PubMed in September 2022. Fasting has the potential to minimize the risk of hypoglycemia in T1DM, lower glycaemic variability, and improve fat metabolism in T1DM and T2DM. It also increases insulin sensitivity, reduces endogenous glucose production in diabetes, lowers body weight, and improves body composition. To conclude, fasting is efficient for therapy management for both people with T1DM and T2DM and can be safely performed, when necessary, with the support of health care professionals.

Diabetic ketoacidosis (DKA) is a life-threatening adverse complication of patients with diabetes mellitus (DM). It is postulated that fasting during Ramadan can increase the risk of DKA; however, there are contradicting data in this regard. Furthermore, studies from Western countries have suggested a seasonal variation in the incidence of DKA. This study examines the differences in the number of DKA episodes during Ramadan compared to the rest of the year in patients with type 1 DM (T1D) and type 2 DM (T2D). Besides, we aim to examine the seasonal difference in the incidence of DKA.

We included consecutive index-DKA admissions from 2015 to 2021 and used descriptive statistics to compare the episodes of DKA in Ramadan vs other months and seasons.

Of 922 patients, 480 (52%) had T1D, whereas 442 (48%) had T2D. The median age (IQR) was 35 (25-45) years, with the majority being Arab (N = 502, 54.4%). There were 94 DKA admissions in six collective Ramadan months, whereas the DKA admissions ranged from 61 to 88 episodes in other months (p = .3). The highest DKA admissions were observed in Autumn (N = 236) and the lowest in Spring (N = 226) with no statistically significant difference (p = .4). There were no differences in DKA severity or new-onset diabetes rates when analyzed based on Hiji months, Roman months, or seasons.

DKA occurrence is not increased during Ramadan. We found no evidence of seasonal variations in the rates of DKA in the State of Qatar.