Metabolic outcomes and insulin therapy modifications during Ramadan fasting in children with type 1 diabetes mellitus in low-resource settings
Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
Department of Child Health, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Department of Child Health, Airlangga General Academic Hospital, Surabaya, Indonesia
Division of Pediatric Endocrinology, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Department of Pediatrics and Genetics, Al-Makassed Hospital and Al-Quds Medical School, East Jerusalem, Palestine
Pediatr Endocrinol Diabetes Metab 2026; 32:
Introduction
Young Muslims with type 1 diabetes mellitus (T1DM) face serious metabolic challenges during Ramadan fasting, particularly hypoglycemia, hyperglycemia, dehydration, and diabetic ketoacidosis (DKA) risks. Data from low-resource settings (LRS) with limited advanced monitoring tools are insufficient despite established guidelines.
Aim of the study
This study planned to evaluate metabolic outcomes and insulin modifications among children and adolescents with T1DM during Ramadan fasting in Surabaya, Indonesia.
Material and methods
Our cross-sectional study recruited 25 individuals with T1DM aged 7 to 18 years who fasted for at least two weeks during Ramadan 2025. Data were collected via questionnaires and glucose logbooks. Fasting blood glucose (FBG) was measured before, during, and after Ramadan. We also evaluated insulin total daily dose (TDD) and acute complication incidences.
Results
The respondents were predominantly female (80%) with a mean HbA1c of 10.22 ±2.29%. During Ramadan, the mean TDD decreased from 0.84 ±0.18 to 0.80 ±0.19 U/kg/day, reflecting a 6.79% reduction in basal insulin. Mean FBG levels remained stable across the pre-, during-, and post-Ramadan periods (202.89, 193.44, and 206.90 mg/dl, respectively; p > 0.05). Clinical safety improved during fasting, with hypoglycemia rates decreasing from 28% to 12% and zero cases of DKA compared to a 16% pre-Ramadan history.
Conclusions
Ramadan fasting is safe and feasible for young Muslims with T1DM in LRS when supported by structured pre-fasting education and individualized insulin modifications. These results emphasize that metabolic stability can be achieved through rigorous monitoring and clinical supervision even in the absence of advanced diabetes technologies.
Keywords
type 1 diabetes mellitus, Ramadan fasting, insulin modifications, metabolic outcomes, low-resource settings
Integrated with
