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CC BY 4.0 · Journal of Diabetes and Endocrine Practice
DOI: 10.1055/s-0045-1811580
Original Article

Effect of Different Insulin Regimens on Individuals with Type 2 Diabetes during Ramadan Fasting in the DAR Global Surveys of 2020 and 2022

Mohamed Hassanein 
1   Department of Diabetes and Endocrinology, Dubai Hospital, Dubai Academic Health Corporation, Dubai, United Arab Emirates
2   Department of Medicine, Gulf Medical University, Ajman, United Arab Emirates
3   Postgraduate Diabetes Education, Cardiff University, Cardiff, United Kingdom
,
Khadija Hafidh 
4   Diabetes Unit, Rashid Hospital, Dubai Academic Health Corporation, Mohamed Bin Rashid University (College of Medicine and Health Sciences), Dubai, United Arab Emirates
,
Muhammad Yakoob Ahmedani
5   Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan
,
Samih A. Odhaib
6   Faiha Specialized Diabetes, Endocrine, and Metabolism Center, University of Basrah, Basrah, Iraq
,
Inass Shaltout
7   Department of Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
,
Mohammed A. Batais
8   Diabetes and Chronic Disease Management, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Rulli Rosandi
9   Internal Medicine Department, Fakultas Kedokteran Universitas Brawijaya, Dr. Saiful Anwar Hospital, Indonesia
,
Mohamed Fariduddin
10   Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
,
Majid Alabbood 
11   Department of Medicine, Gold Coast University Hospital, Queensland, Australia
,
Mehmet A. Buyukbese
12   Gaziantep Islam Science and Technology University, Gaziantep, Turkiye
,
Tong C. Voon
13   Department of Medicine, Malacca General Hospital, Malacca, Malaysia
,
Rachid Malek
14   Service Médecine Interne, CHU Sétif, Algeria
,
Reem Al-Amoudi 
15   Endocrine Department, King Abdul-Aziz Medical City, King Saud Bin Abdulaziz University, Riyadh, Saudi Arabia
,
Abdulla Alzahrani
16   Endocrine Department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
,
Zanariah Hussein
17   Department of Internal Medicine, Hospital Putrajaya, Putrajaya, Malaysia
› Institutsangaben
Funding and Sponsorship None.
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Abstract

Introduction

The DAR (Diabetes and Ramadan International Alliance) global surveys of 2020 and 2022 presented a unique opportunity to study the differences among various insulin treatment regimens during Ramadan fasting in individuals with diabetes to better understand the risks and complications associated with insulin therapy between the different regimens.

Patients and Methods

Individuals with type 2 diabetes on an intensive insulin regimen were categorized into two cohorts: 1,527 receiving basal-bolus insulin (14.1%) and 1,355 on premixed insulin (12%). We examined the patterns of differences between the two cohorts concerning baseline characteristics, diabetes-related complications, dysglycemia occurrence, and hospitalization rates during fasting.

Results

The mean age was similar between cohorts (56.0 ± 12.1 years in basal-bolus vs. 55.1 ± 11.3 years in premixed insulin). However, the basal-bolus group had a significantly longer diabetes duration (14.1 ± 8.4 vs. 12.5 ± 7.5 years, p = 0.03). Other metabolic parameters, including HbA1c, body mass index, blood pressure, and low-density lipoprotein cholesterol levels were not different. Insulin use was slightly higher in women in both groups. Proportions of those who fasted, practiced self-monitoring of blood glucose, and had access to Ramadan-focused education were similar in the two cohorts. The basal-bolus cohort had tended to have increased occurrence of hypoglycemic episodes (23.9% vs. 17.7%, p = 0.08) but similar rates of hypoglycemia (6.5%). Frequent hyperglycemia (≥8 days) and the hyperglycemia-related emergency visits and hospitalizations were significantly higher in the basal-bolus group (9.0% vs. 3.7%, p < 0.001).

Conclusion

Multiple-dose premixed insulin regimens in this study appear less prone to hyperglycemic episodes and hospitalizations. However, a causal relationship cannot be inferred as differences and variations in medical management, prescribing habits, and fasting practices across wider regions must be considered confounding factors. Carefully designed randomized-controlled studies are needed to establish a definitive link.

Keywords

Ramadan fasting - type 2 diabetes - insulin regimen - basal-bolus - premixed insulin

Author Contribution

All named authors contributed to the conduct of the study, data collection and analysis, and drafting and finalization of the manuscript.


Compliance with Ethical Principles

The original surveys received ethics approval from all study sites, and consent was obtained from all participants. Permission to access data from both surveys is granted to all authors.


Data Availability Statement

Data are available upon reasonable request to the corresponding author.




Publikationsverlauf

Artikel online veröffentlicht:
29. August 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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