The month of Ramadan poses a unique clinical challenge for the millions of people with diabetes who wish to fast. But a systematic, well-planned approach allows most of these patients to fast safely, Mohamed Hassanein, professor of medicine at Mohamed Bin-Rashid University and senior consultant in endocrinology and diabetes at Dubai Hospital, Dubai, United Arab Emirates, said at the 37th National Congress of the Spanish Diabetes Society Foundation held in April 2026 in Seville, Spain.

Assess Risk Early

Hassanein said, “Many people will be able to fast once they have education, the necessary adjustments, and an individualized plan.” He stressed that the clinician’s role is not to discourage the patient but to support them with evidence. “We do not tell them to fast or not to fast; we say: This is your level of risk.”

Fasting during Ramadan is obligatory for healthy adult Muslims, but Islamic tradition allows exemptions for people with illnesses. For people with diabetes, the expert advocates an individualized risk-assessment strategy before the holy month begins, ideally 3 or 4 months in advance. “Preparing your community and your colleagues at work ahead is really important,” Hassanein said, noting that 40% of patients with diabetes currently do not receive Ramadan-specific education.

He summarized the key recommendations of the Diabetes and Ramadan (DaR) Practical Guidelines, developed by the International Diabetes Federation in partnership with the DaR Alliance, which are regarded as the international reference standard. The guideline focuses on risk stratification (from very high to low) and recommends a pre‑Ramadan education to adjust medications and prevent glycemic crises. It advises taking the suhur (the pre-dawn meal) as late as possible and the iftar (the meal to break the fast at sunset) as early as possible, choosing complex carbohydrates (brown rice or oats) and limiting sweets.

Medication Timing Matters

From a pharmacologic standpoint, most modern antidiabetic drugs show a low-risk profile during fasting. Metformin, DPP‑4 inhibitors, GLP‑1 receptor agonists, and the GLP‑1/glucose-dependent insulinotropic polypeptide combination do not require dose reductions, only schedule adjustments to match the patient’s meals.

For sulfonylureas and insulin, Hassanein recommends dose reductions in well-controlled patients. As for SGLT2 inhibitors, available evidence does not show an increased risk for dehydration, renal impairment, or ketoacidosis, although the expert advised not to start them during Ramadan itself.

The most critical period for safety is the last hours before breaking the fast. “It’s when the body’s glycogen stores are depleted, but the treatment may still be active. That’s when hypoglycemic episodes occur most frequently,” the specialist said, emphasizing that glucose monitoring should be intensified precisely during that time window.

Nutrition and Hydration

From a nutritional standpoint, the expert reminds us that the Ramadan meal should follow the same principles as a healthy diet — “high in fiber, low in rapidly absorbed carbohydrates, and accompanied by ample water intake.” Hassanein also warned against excessive consumption of salty foods and caffeine since caffeine increases the sensation of thirst the following day.

To support patient education, Hassanein’s team has developed a free, noncommercial app available in English, Arabic, French, and Urdu, with a Spanish version in development.

The end of Ramadan should not mark the close of the clinical episode, but the opposite. “It’s a great opportunity to evaluate how the patient did, whether they had problems and what the causes were, so we can improve for the next year,” Hassanein said. He added that “using Ramadan as an excuse not to intensify treatment is not correct. We need to aim for healthy diabetes management year‑round.”

Hassanein’s presentation was accompanied by Ana Belén Ruiz Jiménez, a coordinator of a newly created working group within the Spanish Diabetes Society (SED) on multiculturalism and diabetes, and by Francisco Javier Ampudia-Blasco, executive president of the SED. “Good diabetes care is not just adjusting a regimen or prescribing a diet; it also means understanding the person in front of you, their history, beliefs, fears, real possibilities, and daily barriers. That’s why multiculturalism must be considered in our daily clinical practice,” Jiménez said.

This article was translated from El Médico Interactivo on Univadis, part of the Medscape Professional Network.