Meta-analysisindependent cross-checkabstract checked★ key study I-FAST-110 standard review
Teenagers with type 1 diabetes fasting Ramadan
Ramadan fasting among adolescents with type 1 diabetes: a systematic review and meta-analysis.
Overview
Safari O et al.. BMC Endocr Disord 2025 · PMID 39966830 · DOI 10.1186/s12902-025-01835-1
Low blood sugar was very common and high sugar and ketoacidosis also occurred in fasting teenagers with type 1 diabetes.
Does the study support the specific claim? No · Methodological quality: low
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Summarise risks of Ramadan fasting for teenagers with T1D.
- How was the study done?
Meta-analysis of 9 studies.
- How many people, animals or samples were studied?
458 adolescents.
- What was actually found?
No change in HbA1c; frequent hypoglycaemia; some hyperglycaemia and DKA.
- How large was the observed effect?
Hypoglycaemia 50.79/100 observations.
- What do the results mean in everyday life?
Children with type 1 diabetes need close supervision if they fast.
- What are the study's limitations?
Small observational studies.
- What does it say about Elawady's specific claim?
Contradicts a relaxed attitude to high glucose and ketones in fasting people with diabetes.
- Do the results apply to Germany and Europe?
Relevant to Muslim families in Europe and Egypt.
- What can explicitly not be concluded from this study?
Exact DKA risk.
Scientific in-depth review
1. Full reference
- Authors
- Safari O et al.
- Journal
- BMC Endocr Disord
- Year
- 2025
- Identifier
- PMID 39966830 DOI 10.1186/s12902-025-01835-1
- Verification
- verified – PubMed efetch 2026-10-26; Crossref update-to/updated-by check
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Authors declare no competing interests.
2. Research question
What are the effects of Ramadan fasting on glycaemic control and acute complications in adolescents with T1D?
3. Study design and population
- Study design
- Meta-analysis – Systematic review and meta-analysis of observational studies
- Population
Adolescents with type 1 diabetes who fasted Ramadan
- Country
Multiple (Middle East and others)
- Period
Search to 13 Feb 2024
- Sample size
9 studies, 458 participants
- Inclusion and exclusion criteria
not stated in abstract
4. Methods and endpoints
- Exposure / intervention
Ramadan fasting
- Comparator
Pre-Ramadan
- Endpoints
HbA1c, hypoglycaemia, hyperglycaemia, DKA, weight
- Statistical methods
Random effects; RR and SMD; Newcastle-Ottawa
5. Actual results
- Results
HbA1c not significantly changed (SMD -0.12, 95% CI -0.38 to 0.14). Hypoglycaemia incidence 50.79 events per 100 observations; hyperglycaemia and DKA also reported but less frequently; high heterogeneity.
- Absolute risks
not reported
- Authors' conclusion
Fasting may be feasible under careful monitoring, but the high hypoglycaemia incidence requires vigilant monitoring and tailored management.
6. Strengths
- Focus on a vulnerable group (children/adolescents)
7. Weaknesses
- Small observational studies; high heterogeneity
- DKA rates not quantified in abstract
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Observational primary studies; heterogeneity.
9. Assessment of the statistical interpretation
High event rate for hypoglycaemia (about 1 event per 2 observations); DKA reported but not pooled in abstract.
10. Relevance to the specific claim
Shows that fasting adolescents with T1D experience frequent hypoglycaemia and some hyperglycaemia/DKA; fasting is feasible only with monitoring.
11. Independent contrary findings
12. Transferability to Germany and Europe
Universal biology; applies in Europe and Egypt.
13. Overall methodological judgement
Supports the safety note for children/adolescents with T1D.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | low |
| Risk of bias | some concerns |
| Precision of results | low |
| Directness | direct |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | inconsistent |
| 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