Ramadan Fasting in Young Adults with Type 1 Diabetes — Influence of Insulin Type and glycemic Control

Abstract

Background: Ramadan fasting is a fundamental religious practice for Muslims worldwide, requiring abstinence from foods, drinks, and oral medications from dawn to sunset. For patients with Type 1 Diabetes Mellitus (T1DM) fasting has significant possible risks, mainly fluctuations in blood glucose level (hypoglycemia, and hyperglycemia). Despite these risks, many diabetic patients choose to adhere to fast Ramadan, often without proper medical guidance and even against medical advices in some cases. Understanding the impact of fasting on glycemic control and accordingly insulin management is crucial for ensuring safety of diabetic young patients. Objectives: To evaluate the safety and health effects of Ramadan fasting among university students with T1DM (frequency of fasting, incidence of hypoglycemia and hyperglycemia, and impact of different insulin types on glycemic control during Ramadan). Methodology: This is an observational cross-sectional study conducted on Delta university students, during Ramadan 1444 Hijri (March 23–April 21, 2023). A total of 164 students with T1DM (aged 18–24 years) were recruited. Participants were monitored for fasting duration, types of insulin adjustments, glycemic fluctuations, HbA1c levels, and LDL changes. Self-monitoring of blood glucose levels was measured, then data was statistically analyzed using SPSS software. Results: The study showed that fasting was generally well tolerated, with a median fasting duration of 26 days. However, glycemic fluctuations were common among participants. Hyperglycemia occurred most frequently 2 hrs after Iftar (51.2%), while hypoglycemia was most prevalent before Iftar (43.3%). Participants using human insulin (short-acting human insulin) had a significantly higher risk of developing hypoglycemia compared to those using insulin analogues (rapid-onset insulin analogue) (OR = 1.45, 95% CI: 1.27–2.72, p = 0.007). No sever hypoglycemic episodes need assistance or hospitalization were reported. No significant changes were observed in HbA1c or LDL levels post-Ramadan. Conclusion: The findings suggest that with proper professional medical supervision, individualized insulin adjustments, and frequent self or continuous glucose monitoring, students with T1DM can fast during Ramadan. However, the risk of glycemic fluctuations remains high, particularly among those using short-acting human insulin. Pre-Ramadan education and structured insulin management plans are crucial to minimize these risks. Further research is needed to develop standardized fasting guidelines for adolescents with T1DM to optimize their safety and metabolic outcomes.