Original Research

Impact of Ramadan Fasting on Patients with Diabetes Type 1 Diabetes Mellitus: An Observational Study From Pakistan

Atif Munir1
Fatima Memorial College of Medicine and Dentistry. Lahore, Pakistan
Fahad Anwer2
King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
Mohammad Imtiaz Hasan3
Diabetes Institute Pakistan Lahore, Pakistan
Kiran S. Choudhry4
Shalamar Hospital, Lahore, Pakistan
Anum Anwar5
Meethi Zindagi, Lahore, Pakistan
Uzma Malik6
King Edward medical University, Lahore, Pakistan.

✉ Correspondence: Atif Munir Email: atif113_2000@yahoo.co.uk

DOI https://doi.org/10.70302/jpsim.v7i1.2605
Volume: 7, Issue 1 Pages: 22–27 Published: 10 Mar 2026
Received: 17 Jul 2025 Revised: 05 Jan 2026 Accepted: 17 Feb 2026 Published Online: 10 Mar 2026

Abstract

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.

Methods

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 years) had higher hypoglycemia rates (80% vs. 34.8%, *p*=0.133) and were more likely to break fasts due to hypoglycemia (80% vs. 21.7%, *p*=0.026). Mean HbA1c was higher in younger patients (8.3% vs. 7.3%, *p*=0.008). No hospitalizations occurred. Most participants (50%) fasted >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.

How to Cite This Article

Munir A, Anwer F, Hasan MI, Choudhry KS, Anwar A, Malik U. Impact of Ramadan Fasting on Patients with Diabetes Type 1 Diabetes Mellitus: An Observational Study From Pakistan. J Pak Soc Intern Med. 2026;7(1):22–27. doi:10.70302/jpsim.v7i1.2605

Conflict of Interest

All authors declare no competing interests.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

No specific funding was received for this research.

Funder information follows the Crossref Funder Registry standard.

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Reference list indexed for Google Scholar and ResearchGate. DOI links resolve via doi.org.

CC BY CC BY 4.0 This article is published under the Creative Commons Attribution 4.0 International License. May be shared and adapted with attribution. © 2026 Journal of Pakistan Society of Internal Medicine.
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