Guideline / position statementindependent cross-checkfull text checked★ key study I-FAST-108 in-depth review
Ramadan guidelines for people with diabetes
Diabetes and Ramadan: Practical Guidelines 2021 (IDF-DAR), International Diabetes Federation and DAR International Alliance
Overview
International Diabetes Federation and DAR International Alliance (ed. Hassanein M). IDF (Brussels) 2021
People with diabetes who fast must stop fasting if blood sugar goes above 300 mg/dL or below 70 mg/dL.
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?
Give practical advice for safe fasting with diabetes.
- How was the study done?
International expert guideline.
- How many people, animals or samples were studied?
not applicable
- What was actually found?
Risk stratification; break-fast thresholds; T1D high risk.
- How large was the observed effect?
not applicable
- What do the results mean in everyday life?
High blood sugar during fasting is a reason to stop fasting and check for danger, not a sign of health.
- What are the study's limitations?
Consensus-based.
- What does it say about Elawady's specific claim?
Contradicts the claim for people with diabetes.
- Do the results apply to Germany and Europe?
Used by clinicians in Egypt and the Gulf and by European diabetes services for Muslim patients.
- What can explicitly not be concluded from this study?
Precise risk of DKA per fasting day.
Scientific in-depth review
1. Full reference
- Authors
- International Diabetes Federation and DAR International Alliance (ed. Hassanein M)
- Journal
- IDF (Brussels)
- Year
- 2021
- Identifier
- Verification
- verified – Full PDF downloaded from the IDF resource page (https://idf.org/about-diabetes/resources/diabetes-and-ramadan-practical-guidelines-2021/) on 2026-10-26; ISBN 978-2-930229-99-7
- Retracted
- no
- Corrections
- none
- Extent checked
- full text
- Conflicts of interest and funding
Not assessed (guideline book).
2. Research question
How should people with diabetes who choose to fast during Ramadan be assessed and managed?
3. Study design and population
- Study design
- Guideline / position statement – International practice guideline (book, 2021 edition); co-authored by Egyptian, Gulf and international diabetologists
- Population
People with type 1 and type 2 diabetes who fast in Ramadan
- Country
International (incl. Egypt: chapter authors from Cairo, Sohag and Alexandria universities)
- Period
not stated in abstract
- Sample size
not applicable
- Inclusion and exclusion criteria
not stated in abstract
4. Methods and endpoints
- Exposure / intervention
Ramadan fasting
- Comparator
not applicable
- Endpoints
Risk stratification, monitoring, when to break the fast
- Statistical methods
not applicable
5. Actual results
- Results
'ALL INDIVIDUALS SHOULD BREAK THEIR FAST IF: Blood glucose <70 mg/dL (3.9 mmol/L) ... Blood glucose >300 mg/dL (16.7 mmol/L) ... Symptoms of hypoglycaemia or acute illness occur' (T1DM chapter, p. 192; similar on p. 122). 'People with T1DM have been categorised as high and very high risk for developing specific complications during Ramadan-fasting such as hypoglycaemia, hyperglycaemia and dehydration.' Physiology chapter: 'During fasting, circulating glucose levels fall and insulin secretion is supressed'. Fluid chapter: evidence does not support pathological dehydration from Ramadan fasting 'in normal circumstances', but dehydration may matter in hot climates, intensive physical labour and with osmotic diuresis from hyperglycaemia.
- Absolute risks
not reported
- Authors' conclusion
People with diabetes need pre-Ramadan risk assessment, education, dose adjustment and glucose monitoring, and must break the fast at defined thresholds.
6. Strengths
- Specific to Ramadan fasting and to the Arab/Egyptian context
- Full text read
7. Weaknesses
- Largely consensus-based; observational evidence
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- not assessable
- Rationale
Guideline.
9. Assessment of the statistical interpretation
Not applicable.
10. Relevance to the specific claim
States that glucose falls in physiological fasting and that people with diabetes must break the fast when glucose exceeds 300 mg/dL - directly contrary to treating high glucose plus ketones as a sign of a healthy liver.
11. Independent contrary findings
12. Transferability to Germany and Europe
Universal biology; applies in Europe and Egypt.
13. Overall methodological judgement
Authoritative, regionally relevant guideline that contradicts the claim's safety message.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | not assessable |
| Precision of results | not applicable |
| Directness | direct |
| Reproducibility | not replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
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
- Do not drink much water because it distends the abdomen and raises abdominal pressure; even when thirsty during long fasting hours just wet the lips; fasting three days in a row each week without food and drink is not harsh. – Studies with mixed or unclear results