Ramadan and Diabetes: A Narrative Review and Practice Update

Area of Science:

• Endocrinology and Metabolism
• Public Health and Epidemiology
• Religious Studies and Bioethics

Background:

• Ramadan fasting is obligatory for Muslims, with fasting durations varying globally and seasonally.
• Individuals with diabetes mellitus often have a strong desire to fast, even when at high risk.
• Self-management of diabetes during Ramadan can be challenging due to underappreciated risks and healthcare provider communication gaps.

Purpose of the Study:

• To review the scientific and clinical evidence regarding fasting in patients with diabetes mellitus during Ramadan.
• To provide recommendations for the management of diabetes patients during Ramadan.
• To emphasize the importance of pre-Ramadan risk stratification and patient counseling.

Main Methods:

• Comprehensive review of current scientific and clinical evidence on diabetes management during Ramadan.
• Inclusion of data on type 1 and type 2 diabetes mellitus, pregnancy, pancreatic diabetes, bariatric surgery, and the elderly.
• Analysis of current practice guidelines and therapeutic options for hypoglycemic agents.

Main Results:

• Pre-Ramadan assessment is critical for risk stratification (low to very high risk) and appropriate counseling.
• High-risk individuals, including those with COVID-19, are advised not to fast.
• Technological advancements in insulin delivery and glucose monitoring aid management for high-risk patients.
• Sufficient evidence exists for the safety and efficacy of various hypoglycemic agents, enabling informed decisions.

Conclusions:

• Personalized management strategies, including risk stratification and close monitoring, are essential for safe Ramadan fasting in diabetes patients.
• Ramadan offers an opportunity for patient engagement to improve diabetes control and promote sustainable healthy habits.
• Adherence to dietary and behavioral discipline during and after Ramadan can help prevent long-term complications.