Fasting safely during Ramadan with diabetes: clinical practice recommendations for Arab populations from the Arab Diabetes Forum (FSR—ADF)

Abstract

Ramadan fasting is a central religious practice observed by millions of Muslims worldwide, including individuals with diabetes. This expert consensus statement from the Arab Diabetes Forum aims to critically appraise the scientific validity and clinical utility of the International Diabetes Federation—Diabetes and Ramadan Alliance (IDF-DAR) risk stratification tool in the context of real-world Ramadan fasting. The IDF-DAR tool provides a structured framework for pre-Ramadan counseling, its scoring system being based on expert opinion rather than validated clinical outcomes. Observational evidence indicates that morbidity and mortality do not increase during Ramadan, even among high-risk individuals who choose to fast. Fasting has also been associated with favorable metabolic effects, including improved lipid profiles, modest weight reduction, enhanced insulin sensitivity, and potential neuroprotective and immunomodulatory benefits. Despite these findings, limited access to structured education and low attendance at pre-Ramadan clinics reduce the tool’s practical impact of current recommendations. This consensus emphasizes a patient-centered, culturally informed approach that respects autonomy and integrates individualized education and ongoing clinician-patient communication. A contextual re-evaluation of current risk stratification models is proposed to better align endocrine and metabolic guidance with real-world fasting practices and optimize diabetes care during Ramadan.