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CC BY 4.0 · Journal of Diabetes and Endocrine Practice
DOI: 10.1055/s-0045-1812089
Original Article

Impact of Albuminuria and Renal Function on Ramadan Fasting in Type 2 Diabetes

Authors

  • Bachar Afandi

    1   Division of Endocrinology, Tawam Hospital and Sheikh Tahnoun Medical City, Al Ain, United Arab Emirates
    2   Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates

  • Yakoob Ahmedani

    3   Department of Diabetes, Tabba Heart Institute, Karachi, Pakistan

  • Yousef Boobes

    4   Department of Nephrology, Seha Kidney Care, Tawam Hospital, Al Ain, United Arab Emirates

  • Alaaeldin Bashier 

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

  • Sanobia Yousef

    3   Department of Diabetes, Tabba Heart Institute, Karachi, Pakistan

  • Georgios Ponirakis

    7   Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar

  • Rayaz A. Malik 

    7   Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar

  • Reem Alamoudi 

    8   Department of Endocrinology, King Saud bin Abdulaziz University, King Abdulaziz Medical City, King Saud University, Jeddah, Saudi Arabia

  • Inass Shaltout

    9   Department of Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt

  • Rachid Malek

    10   Department of Endocrinology, Setif University Ferhat Abbas, Algiers, Algeria

  • Zanariah Hussein

    11   Medical Endocrine Unit, Department of Internal Medicine, Endocrine Institute Hospital, Putrajaya, Malaysia

  • Khadija Hafidh 

    12   Diabetes Unit, Rashid Hospital, Dubai, United Arab Emirates

  • Mohamed Hassanein 

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

Funding Sources None.
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Abstract

Background

Diabetic kidney disease (DKD) is a common and serious complication, defined by albuminuria and/or reduced estimated glomerular filtration rate (eGFR).

Objectives

This study explored the impact of DKD and its subgroups on glycemic control and fasting safety during Ramadan.

Patients and Methods

We analyzed data from the Diabetes and Ramadan Global Survey (2020–2022), including 12,529 participants with type 2 diabetes across seven regions. Participants were classified into four groups: no DKD (n = 10,780), DKD with albuminuria only (n = 460), DKD with low eGFR only (n = 1,150), and DKD with both albuminuria and low eGFR (n = 140). Outcomes included fasting patterns, hypoglycemia, hyperglycemia, and related interruptions.

Results

Most participants intended to fast (no DKD 86.5%, albuminuria only 80.0%, low eGFR only 76.4%, and albuminuria + low eGFR 80.6%). Mean fasting duration was ∼27 days across groups; however, those with reduced eGFR were more likely to fast only 1 to 7 days (6.4 vs. 2.4% without DKD, p < 0.0001). Daytime hypoglycemia occurred in 14.5% (no DKD), 19.0% (albuminuria only), 23.7% (low eGFR only), and 25.0% (albuminuria + low eGFR). Breaking fast due to hypoglycemia was more frequent in DKD groups (14.9–19.6 vs. 8.2% without DKD, p < 0.0001). Hyperglycemia was most frequent in albuminuria only (24.2%) and low eGFR only (18.4%) compared with no DKD (14.5%, p < 0.0001). Severe hyperglycemia was highest in low eGFR-only (2.0 vs. 0.8% without DKD, p < 0.001).

Conclusion

Ramadan fasting is common among people with type 2 diabetes and DKD, but carries greater risks of both hypoglycemia and hyperglycemia. Albuminuria may signal reduced physiological resilience and glycemic stability, even when eGFR is preserved, while reduced eGFR confers the highest risk. Comprehensive pre-Ramadan assessment and tailored education are essential to support safer fasting in this high-risk population.

Keywords

Ramadan fasting - diabetic kidney disease - eGFR - albuminuria - hypoglycemia - hyperglycemia

Authors' Contribution

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


Compliance with Ethical Principles

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




Publication History

Article published online:
31 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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