Ramadan fasting and diabetes in adolescents and children: A narrative review

Abstract

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...

Ramadan and Diabetes: A Narrative Review and Practice Update

“…Consider reducing the morning dose (at Suhoor) in paƟents with well-controlled blood glucose levels by 25-50%. benefits [104]. Further studies, described in subsequent sections of this review, demonstrate the benefits of Ramadan-specific education comined with technology use.…”

“…Regular monitoring and dose adjustments have been shown to minimize hypoglycaemic events and DKA [ 72 ]. Other educational approaches specifically devised for Ramadan have demonstrated benefits [ 104 ]. Further studies, described in subsequent sections of this review, demonstrate the benefits of Ramadan-specific education comined with technology use.…”

Ramadan Fasting Among Older Children and Adolescents With Type 1 Diabetes Mellitus: A Real-World Study From the UAE

“…The recent 2021 recommendations of the (IDF)/Diabetes and Ramadan (DAR) Alliance ( 19 ) discourage children and adolescents with T1DM to practice RF. However, many children and adolescents choose to fast ( 20 ), presenting a challenge to health care providers. Children and adolescents can be even more eager to fast compared to their adult family members, a phenomenon related to self-esteem and happiness ( 21 , 22 ).…”

Ramadan 2020 and Beyond in the Midst of the COVID-19 Pandemic: Challenges and Scientific Evidence For Action

“…The effects of RF on diabetes among children and adolescents have been examined mainly in T1D [105,106]. Evidence supported the fact that around 60% of children and teenagers with T1D are able to fast more than half of the month of Ramadan and that they can fast safely in association with proper focused education before Ramadan and close follow-up during Ramadan, where patients are advised to break their fasting during hypo/hyperglycemia [107][108][109].…”

“…Furthermore, most of the recent studies reported that RF was not associated with an increased risk of diabetic ketoacidosis (DKA) [110]. However, other studies considered this group as a high-risk group who should not fast during the month of Ramadan as it may increase the incidence of DKA, dehydration, and hypoglycemia among T1D in these age groups [105]. The role of RF in glucose biomarkers among children and adolescents with T2D has not been examined yet.…”