Approximately 1.9 billion Muslims celebrate Ramadan, a time to reflect on the suffering of the less fortunate and foster one’s spirituality and self-restraint. For younger followers with type-1 diabetes, Ramadan also brings uncertainty due to the lack of research and clinical consensus on how the condition should be managed during the month of fasting. A global research group has taken steps to rectify this gap by publishing the first set of comprehensive recommendations for the clinical management of type-1 diabetes in children and adolescents during Ramadan fasting.

Fasting during Ramadan is only mandatory for those to whose health it wouldn’t jeopardise. Even though people with type-1 diabetes can therefore be exempted on medical grounds, the researchers note that many young people with diabetes are driven to fulfil their religious obligations, often without approval from a doctor. 

The group’s new recommendations shed light on the best practices for pre-Ramadan counselling, the importance of regular glucose monitoring, and specific information on insulin therapies, nutrition, and physical activity. The guidelines also give criteria as to when patients should break fasting to protect their health.

The group stress the importance of pre-Ramadan counselling as an essential opportunity to ensure that patients (and caregivers) recognize the symptoms of hypoglycemia, that their diabetes is well controlled, and that they are aware of the risks involved with fasting, and taught how to fast safely. A survey quoted in the paper highlights that many patients are not aware of the extent to which their metabolic control can deteriorate over a month of fasting. 

Despite a host of publications on Ramadan fasting and diabetes, there is a lack of original research and data specifically involving younger patients. Ibrahim Al Alwan, Vice-President of Postgraduate Education and Academic Affairs at King Saud Bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia, and a co-author of the new guidelines, says that he’d like to see new studies, particularly into the epidemiology of type-1 diabetes and its complications. In addition, he hopes to bring attention to the lack of research on “the effect of Ramadan on the management of chronic illness” and on “proper medication adjustment during fasting”.

Al Alwan wants the team’s recommendations to be made available to physicians via endorsement by national paediatric societies. In the meantime, the group’s guidelines offer much-needed consensus and direction for the clinical management of the many young diabetes patients during Ramadan.

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