Cross-sectional studyindependent cross-checkabstract only checked★ key study I-FAST-10 in-depth review
Fasting in Ramadan with diabetes (EPIDIAR)
A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study.
Overview
Salti I et al.. Diabetes Care 2004 · PMID 15451892 · DOI 10.2337/diacare.27.10.2306
Severe low blood sugar was 4.7 times (type 1) and 7.5 times (type 2) more common during Ramadan.
Does the study support the specific claim? No · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Diabetes characteristics and effects of Ramadan fasting
- How was the study done?
Population-based retrospective cross-sectional survey (EPIDIAR)
- How many people, animals or samples were studied?
12,243; Muslims with type 1 or type 2 diabetes
- What was actually found?
Severe hypoglycaemia increased.
- How large was the observed effect?
0.14 vs 0.03/month (T1D)
- What do the results mean in everyday life?
People with diabetes need a plan before fasting.
- What are the study's limitations?
Retrospective, recall
- What does it say about Elawady's specific claim?
Contradicts safety implications of C-FAST-03, C-FAST-05, C-FAST-07; relevant to C-ODD-11.
- Do the results apply to Germany and Europe?
Relevant to Muslim communities in Europe.
- What can explicitly not be concluded from this study?
Mortality effects.
Scientific in-depth review
1. Full reference
- Authors
- Salti I et al.
- Journal
- Diabetes Care
- Year
- 2004
- Identifier
- PMID 15451892 DOI 10.2337/diacare.27.10.2306
- Verification
- verified – PubMed efetch 2026-10-25 (this agent)
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
not stated in abstract
2. Research question
Diabetes characteristics and effects of Ramadan fasting
3. Study design and population
- Study design
- Cross-sectional study – Population-based retrospective cross-sectional survey (EPIDIAR)
- Population
Muslims with type 1 or type 2 diabetes
- Country
13 countries with sizable Muslim populations (country list not given in abstract)
- Period
Ramadan 2001
- Sample size
12,243
- Inclusion and exclusion criteria
As described in the abstract; details not available in abstract.
4. Methods and endpoints
- Exposure / intervention
Ramadan fasting
- Comparator
Other months
- Endpoints
Severe hypoglycaemia; other complications
- Statistical methods
Comparisons of event rates
5. Actual results
- Results
42.8% of T1D and 78.7% of T2D fasted >=15 days. Severe hypoglycaemia T1D 0.14 vs 0.03 episodes/month (P=0.0174); T2D 0.03 vs 0.004 (P<0.0001); more frequent in those changing drug doses or activity.
- Absolute risks
not reported
- Authors' conclusion
Fasting patients with diabetes are a challenge; need for education and guidelines.
6. Strengths
- Large multinational
7. Weaknesses
- Retrospective, recall
8. Risk of bias
- Orienting tool
- ROBINS-E
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Self-report.
9. Assessment of the statistical interpretation
Several-fold increases in severe hypoglycaemia.
10. Relevance to the specific claim
Contradicts safety implications of C-FAST-03, C-FAST-05, C-FAST-07; relevant to C-ODD-11.
11. Independent contrary findings
12. Transferability to Germany and Europe
Relevant to Muslim communities in Europe.
13. Overall methodological judgement
Fasting with diabetes increases severe hypoglycaemia.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
None beyond those stated.
15. Linked fact checks
- Rising blood glucose and acetone (ketones) during fasting are evidence that the liver is working properly, not a danger; high glucose plus acetone is not insulin deficiency. – Studies contradicting or limiting the claim
- Long daily intermittent fasting with one meal a day as the default eating pattern (and sometimes eating once every two days) is the healthy way to eat. – Studies contradicting or limiting the claim
- Eat only when you are hungry and stop when full; no fixed meal times or quantities. – Studies contradicting or limiting the claim