A cornerstone of managing diabetes during Ramadan is patient education, which should include information on risks, glucose monitoring, nutrition, exercise and medication.

Studies have shown that pre-Ramadan counselling reduces episodes of low blood glucose. Pre-Ramadan education provides a platform to remind people with diabetes about the importance of diet and exercise, and that regular glucose monitoring is essential to avoid complications, while reassuring them that this does not invalidate the fast.

With the global prevalence of diabetes continuing to increase, and the number of fasting Muslims set to rise, the importance of effective guidelines for the management of diabetes during Ramadan fasting is clear. The IDF-DAR Practical Guidelines provide healthcare professionals with both background and practical information, as well as management recommendations to optimise the care delivered to people with diabetes who plan to fast during Ramadan.

The IDF-DAR Practical Guidelines 2021 are available for download by clicking on the image on the right. Individual chapters can be downloaded by clicking on the links below.

(All files pdf)

• Acknowledgements & Foreword
• Ch 1: Introduction to the IDF-DAR Practical Guidelines
• Ch 2: Epidemiology of diabetes and fasting during Ramadan
• Ch 3: What happens to the body? Physiology of fasting during Ramadan
• Ch 4: The effects of fasting during Ramadan on physical and mental wellbeing
• Ch 5: Risk stratification of people with diabetes before Ramadan
• Ch 6: Diabetes and Ramadan: A medico-religious perspective
• Ch 7: Pre-Ramadan Assessment and Education
• Ch 8: The Ramadan Nutrition Plan (RNP) for people with diabetes
• Ch 9: Management of Type 1 diabetes when fasting during Ramadan
• Ch 10: Management of Type 2 diabetes when fasting during Ramadan
• Ch 11: Management of hyperglycaemia in pregnancy when fasting during Ramadan
• Ch 12: Management of diabetes among the elderly when fasting during Ramadan
• Ch 13: Risks of fasting during Ramadan: Cardiovascular, Cerebrovascular and Renal complications
• Ch 14: Identifying and overcoming barriers to guideline implementation
• Ch 15: Grading of evidence & areas of future research in diabetes and fasting during Ramadan
• Glossary

The IDF-DAR Practical Guidelines 2021 were made possible through an educational grant from Sanofi and Servier.

Diabetes and Ramadan online course for health professionals

To support health professionals in providing the best possible care for people with diabetes who desire to fast during Ramadan, IDF and the Diabetes and Ramadan Alliance have developed a free online course on Diabetes and Ramadan, available in the IDF School of Diabetes.

The course provides the latest clinical practice recommendations to help health professionals advise people with diabetes to manage the condition effectively and prevent complications. Topics covered include:

• The epidemiology and physiology of diabetes and Ramadan fasting
• Risks associated with fasting in people with diabetes
• Risk categories for people with diabetes who fast during Ramadan
• Ramadan-focused diabetes education
• Pharmacological management of high risk populations

Learn more and register

COVID-19 and fasting with diabetes

The currently available epidemiological data shows that people who fast do not report higher rates of infections or hospitalization. There is therefore no evidence that fasting could lead to reduced immunity and higher risk for infection.

However, people with diabetes and complications, such as renal impairment or foot problems, are at high risker of infections. It is therefore important that they follow medical advice and do not fast to avoid increasing their risk of contracting COVID-19.

• General advice, Diabetes, Ramadan and COVID-19 (Diabetes Ramadan Alliance)