Review Article introduCtionRamadan fasting is one of the cardinal articles of Islam commonly known as "the five Pillars of Islam". [1,2] Fasting is obligatory for all healthy adult and adolescent Muslims. [1,2] Fasting is ordained from the time of completing the puberty which varies from 12 to 16 years of age. Fasting starts from early dawn (Sohur) to sunset (Iftar). During this period, a fasting person has to abstain from eating and drinking. Islam has allowed many categories of people to be exempted from fasting, for example, prepubertal children, travelers, the sick, the elderly, pregnant, and lactating women and individuals with chronic illnesses such as type 1 diabetes mellitus (T1DM).Sick individuals and children are exempted from fasting Ramadan. However, many patients insist on following the fast, often without the approval of their physicians. [3,4] Ramadan fasting represents a significant shift in meal timing and content for practicing Muslims. This naturally affects the bodily homeostasis, metabolic environment, fluid balance, and interaction of foods, drugs, and disease.Fasting by T1DM patients might predispose to acute complications due to the loss of fine balance between insulin action and carbohydrate supply in different directions in the two different times of the fasting cycle. [5] . The global literature production on health aspects of Ramadan fasting is notably relatively low in general as shown in recent review of the whole of publications in one year (2017) [6] . Similarly, a more focused recent bibliometric analysis quantified the global production on Ramadan and diabetes over the last three decades also showed a low volume of scholarly work. [7] There are several review articles and clinical practice guidelines in general with a predictable emphasis on adults. [8][9][10][11][12] However, there are no comprehensive guidelines specifically addressing Although children in general and patients with type 1 diabetes mellitus, in particular, are exempted from fasting during Ramadan, many elect to observe the fast. There is a sizeable amount of opinion and research data that warrants revisiting. This is a narrative nonsystematic review to explore the views and supporting data on Ramadan fasting and to examine the safety of fasting and its impact on diabetes control and management in children and adolescents. The key areas covered include epidemiology, the physiology of fasting, risk stratification, counseling strategy, nutrition advice, insulin therapy adjustment with a particular focus on multiple injection regimen, and insulin pump therapy. Findings from various studies and expert opinions were appraised and presented to illustrate points of agreements and differences. This review should enhance knowledge and form the basis to clear some doubts and differences of opinions surrounding the issue of diabetes and Ramadan fasting in young people. It should also empower healthcare professionals to develop consensus based on the most up-to-date advice and the best possible support to patients and famili...
