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CC BY 4.0 · Journal of Diabetes and Endocrine Practice
DOI: 10.1055/s-0045-1812012
Original Article

Ramadan Fasting in Individuals with Diabetic Retinopathy: A Retrospective Cohort Study from the Diabetes and Ramadan Global Survey

Authors

  • Bachar Afandi

    1   Department of Endocrinology, Tawam Hospital and STMC, Al Ain, United Arab Emirates
    2   Department of Medicine, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates

  • Alaa Attwan

    3   Department of Ophthalmology, Moorfields Eye Hospital, Dubai, United Arab Emirates

  • Georgios Ponirakis

    4   Medicine Department, Weill Cornell Medicine-Qatar, Doha, Qatar

  • Rayaz Malik 

    4   Medicine Department, Weill Cornell Medicine-Qatar, Doha, Qatar

  • Reem Alamoudi 

    5   Department of Endocrinology, King Abdulaziz Medical City, King Saud Bin Abdulaziz University, Jeddah, Saudi Arabia

  • Inass Shaltout

    6   Department of Medicine, Faculty of Medicine, Cairo University/, Cairo, Egypt

  • Rachid Malik

    7   Diabetes Clinic, Setif University Ferhat Abbas, Setif, Algeria

  • Mohamed Habib

    8   Scientific Support Office, Diabetes and Ramadan International Alliance, Alexandria, Egypt

  • Samih Abed Odhaib

    9   Thi Qar Specialized Diabetes Endocrine and Metabolism Center, College of Medicine, Sumer University, Thi Qar, Iraq

  • Zanariah Hussein

    10   Medical Endocrine Unit, Internal Medicine Department, Endocrine Institute Hospital Putrajaya, Putrajaya, Malaysia

  • Khadija Hafidh 

    11   Department Diabetes and Endocrinology, Rashid Hospital, Dubai, United Arab Emirates
    12   Department of Medicine, Mohammed Bin Rashid University, Dubai, United Arab Emirates

  • Mohamed Hasannien 

    12   Department of Medicine, Mohammed Bin Rashid University, Dubai, United Arab Emirates
    13   Department of Endocrinology, Dubai Hospital, Dubai, United Arab Emirates

Funding None.
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Abstract

Background

Data on the impact of diabetic retinopathy (DR) on Ramadan fasting are limited. DR is not currently considered in pre-Ramadan risk stratification. However, its association with longer diabetes duration, poor glycemic control, and insulin use may increase vulnerability to adverse events during fasting.

Objectives

To evaluate fasting safety in patients with DR using data from the Diabetes and Ramadan (DaR) Global Survey.

Patients and Methods

This retrospective cohort study analyzed data from the DaR Global Survey conducted in 2020 and 2022 across multiple world regions. Patients with confirmed DR (DR group, n = 1,795) were compared with individuals without DR (control group, n = 10,735). Demographic and clinical data were collected through structured post-Ramadan clinic interviews. Primary outcomes included self-reported hypoglycemia, hyperglycemia, emergency visits, hospitalizations, and fasting interruption. Multivariate logistic regression was used to adjust for age, sex, diabetes duration, glycated hemoglobin (HbA1c), and insulin use.

Results

Individuals with DR had longer diabetes duration, comparable HbA1c, and greater insulin use compared with those without DR. DR was independently associated with a 45% lower likelihood of fasting during Ramadan (adjusted odds ratio [AOR]: 0.55, p ≤ 0.0001). Among those who fasted, hypoglycemia rates were similar in the DR (16.2%) and non-DR (14.6%) groups (p = 0.5), but hyperglycemia was more prevalent in DR (24.1 vs. 13.8%; p < 0.001). DR was also independently associated with breaking the fast due to hypoglycemia (AOR: 1.34), hypoglycemia requiring medical attention (AOR: 1.76), and hyperglycemia (AOR: 1.50).

Conclusions

DR was independently linked to lower fasting rates and higher risks of hypoglycemia, hyperglycemia, and medical interventions during Ramadan. These findings underscore the importance of incorporating DR assessment into fasting risk stratification tools to improve patient safety.

Keywords

diabetic retinopathy - Ramadan fasting - hypoglycemia - hyperglycemia - risk assessment - diabetes education - fasting complications

Authors Contributions

All authors contributed toward conception, data collection, writing, and final approval of the manuscript.


Compliance with Ethical Principles

Ethical approval was granted for the DAR Global Survey from Dubai Health Authority.




Publication History

Article published online:
16 October 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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