JPSIM Journal of Pakistan Society of Internal Medicine J Pak Soc Intern Med 2709-8729 2710-0804 Pakistan Society of Internal Medicine 10.70302/jpsim.v7i1.2605 jpsim.v7i1.2605 Original Research Impact of Ramadan Fasting on Patients with Diabetes Type 1 Diabetes Mellitus: An Observational Study From Pakistan Munir Atif atif113_2000@yahoo.co.uk * Anwer Fahad Hasan Mohammad Imtiaz Choudhry Kiran S. Anwar Anum Malik Uzma Fatima Memorial College of Medicine and Dentistry. Lahore, Pakistan King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia Diabetes Institute Pakistan Lahore, Pakistan Shalamar Hospital, Lahore, Pakistan Meethi Zindagi, Lahore, Pakistan King Edward medical University, Lahore, Pakistan. *Correspondence: Atif Munir (atif113_2000@yahoo.co.uk) 10 03 2026 2026 7 1 22 27 17 07 2025 05 01 2026 17 02 2026 Copyright © 2026 The Author(s) 2026 The Author(s) https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective

This study assessed the impact of pre-Ramadan medical assessment, education, and individualized insulin adjustments on diabetes-related complications in fasting T1DM patients under medical supervision.

 Methodology

A prospective observational study was conducted at Fatima Memorial Hospital, Lahore, involving 28 T1DM patients (82.1% aged ≥20 years, 67.9% female). Participants underwent pre-Ramadan risk stratification (IDF-DAR guidelines), structured education, and insulin regimen optimization. During Ramadan, remote monitoring via WhatsApp provided real-time support. Outcomes included hypoglycemia, hyperglycemia, DKA, and hospitalization rates.

 Results

Younger participants (20 days, with 11.3% completing all fasts. Frequent glucose self-monitoring was associated with better outcomes (*p*=0.03 for females).

 Conclusion

Pre-Ramadan assessment, education, and remote supervision enable safer fasting in low-to-intermediate- risk T1DM patients. Younger individuals and those with poorer glycemic control require closer monitoring. Structured interventions mitigate acute complications, though larger studies are needed to refine guidelines.

 Keywords Ramadan fasting Type 1 diabetes hypoglycemia insulin adjustment Pakistan. Ethics Statement

Ethics committee: Institutional Review Board, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Pakistan. Approval number: FMH-21/3/2023-IRB-1192, dated April 26, 2023.

 References Al-Arouj M, Bouguerra R, Buse J, Hafez S, Hassanein M. Recommendations for the management of diabetes during Ramadan. Diab Care. 2005;28(9):2305-11. Ibrahim A. Managing diabetes during Ramadan. Diab Voice. 2007; 52:19–22. Salti I, Bénard E, Detournay B, Bianchi-Biscay M, Le Brigand C. A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diab Care. 2004;27(10):2306-11. Hassanein M, Echtay A, Hassoun A, Alarouj M, Afandi B. The characteristics and pattern of care for the type 2 diabetes mellitus population in the MENA region during Ramadan: An international prospective study (DAR MENA T2DM). Diabetes Res Clin Pract. 2019; 151:275-84. Hassanein M, Al-Arouj M, Hamdy O, Bebakar WMW, Jabbar A, El Tony L, et al. Ramadan fasting in people with type 1 diabetes during COVID-19 pandemic: The DaR Global survey. Diabetes Res Clin Pract. 2020;166:108226. Beshyah SA, Hassanein M, Ahmedani MY, Shaikh S, Ba-Essa EM. Fasting during the month of Ramadan for people with diabetes: the pros and cons. Diabet Med. 2010;27(3):257-61. Hassanein M, Afandi B, Ahmedani MY, Alamoudi RM, Alawadi F, Bajaj HS, et al. Diabetes and Ramadan: Practical guidelines 2021. Diabetes Res Clin Pract. 2022;185:109185. Al-Arouj M, Assaad-Khalil S, Buse J, Fahdil I, Fahmy M. Recommendations for the management of diabetes during Ramadan: update 2010. Diabetes Care. 2010;33(8):1895-902. Azad K, Mohsin F, Zargar AH, Zabeen B, Ahmad J, Raza SA, et al. Fasting guidelines for diabetic children and adolescents. Indian J Endocrinol Metab. 2012;16(4):516-8. Pathan MF, Sahay RK, Zargar AH, Raza SA, Khan AK, Ganie MA, et al. South Asian Consensus Guideline: use of insulin in diabetes during Ramadan. Indian J Endocrinol Metab. 2012;16(4):499-502. Kobeissy A, Zantout MS, Azar ST. Suggested insulin regimens for patients with type 1 diabetes mellitus who wish to fast during the month of Ramadan. Clin Ther. 2008;30(8):1408-15. Elhadd T, Dabbous Z, Bashir M, Siddique M, Al-Muhannadi H. Continuous glucose monitoring and fasting in Ramadan: An observational study. J Diabetes Sci Technol. 2020;14(2):318-24. Hassanein M, Alamoudi RM, Kallash M, Ibrahim M, Aljohani N. Management of diabetes during Ramadan: update 2020. Diabetes Res Clin Pract. 2021;162:108084. Deeb A, Al Qahtani N, Attia S, Al Suwaidi H, Nagelkerke N. Does reducing basal insulin during Ramadan fasting by children and adolescents with type 1 diabetes decrease the risk of symptomatic hypoglycemia? Diabetes Technol Ther. 2016;18(9):539-42. Afandi B, Hassanein M, Roubi S, Nagelkerke N. Effect of structured education on diabetes management during Ramadan. J Diabetes Res. 2019; 2019:7596281. Rinker J, Dickinson JK, Litchman ML, Williams AS, Kolb LE, Cox C, et al. The 2017 diabetes educator and the diabetes self-management education national practice survey. Diabetes Educ. 2018;44(3):260-8. Pearson TL, Warshaw H, Allweiss P, Fulkerson R, Hanes S. Population health: the diabetes educator’s evolving role. Diabetes Educ. 2019;45(4):333-48. Bajaj HS, Abouhassan T, Ahsan MR, Alguwaihes AM, Al-Ozairi E, Houlden RL, et al. Diabetes Canada position statement for people with types 1 and 2 diabetes who fast during Ramadan. Can J Diabetes. 2019;43(1):3-12. Al Awadi FF, Echtay A, Al Arouj M, Al Ozairi E, Al Saeed M, Al Shaikh A, et al. Patterns of Diabetes Care Among People with Type 1 Diabetes During Ramadan: An International Prospective Study (DAR-MENA T1DM). Adv Ther. 2020;37(5):1940-53.