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CC BY 4.0 · Journal of Diabetes and Endocrine Practice 2026; 09(01): 123-129
DOI: 10.1055/s-0045-1813011
Original Article

Impact of Microvascular Complications on Glycemic Outcomes in People with Type 2 Diabetes Observing Ramadan Fasting

Authors

  • Georgios Ponirakis    *

    1   Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar

  • Mohamed Hassanein    *

    2   Dubai Health and Mohammed Bin Rashid University of Medicine and Health Sciences, College of Medicine, Dubai, United Arab Emirates

  • Bachar Afandi

    3   Tawam Hospital and College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates

  • Khadija Hafidh 

    2   Dubai Health and Mohammed Bin Rashid University of Medicine and Health Sciences, College of Medicine, Dubai, United Arab Emirates

  • Shehla Shaikh

    4   Department of Endocrinology and Diabetes, KGN Diabetes and Endocrinology Centre, Mumbai, India

  • Inass Shaltout

    5   Arabic Association for the Study of Diabetes and Metabolism, Cairo, Egypt

  • Rashed Malek

    6   Department of Internal Medicine, CHU Setif, Setif, Algeria

  • Mehmet Akif Buyukbese 

    7   Department of Endocrinology and Metabolism, Faculty of Medicine, Gaziantep Islam Science and Technology University, Gaziantep, Türkiye

  • Zanariah Hussein

    8   Department of Endocrinology, Putrajaya Hospital, Putrajaya, Malaysia

  • Fatimah Eliana

    9   Department of Internal Medicine, Faculty of Medicine, Yarsi University, Jakarta, Indonesia

  • Reem Alamoudi 

    10   Department of Medicine, King Abdulaziz Medical City and King Abdullah International Research Centre, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
    11   Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia

  • Muhammad Yakoob Ahmedani

    12   Department of Endocrinology and Diabetes, Tabba Heart Institute, Karachi, Pakistan

  • Rayaz Ahmed Malik 

    1   Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar

Funding None.
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Abstract

Background

Fasting during Ramadan may increase the risk of hypoglycemia and hyperglycemia in people with type 2 diabetes mellitus (T2D). This study investigated whether the presence of microvascular complications increases the risk of such events during Ramadan fasting.

Materials and Methods

This cross-sectional analysis analyzed data on demographics, neuropathy, nephropathy, retinopathy, and fasting-related glycemic events from the 2020 and 2022 Diabetes and Ramadan Global Surveys of adults with T2D.

Results

Of 12,529 individuals, 10,707 (85.5%) fasted during Ramadan. Of those, 15.5% experienced hypoglycemia and 15.1% hyperglycemia, with 9.2 and 3.4% breaking their fast due to each, respectively, and 1.8 and 0.9% experienced severe hypo- and hyperglycemia requiring medical intervention, respectively. Having ≥1 microvascular complication more than doubled the odds of daytime hypoglycemia (odds ratio [OR] = 2.16–2.31, p ≤ 0.0001) and hyperglycemia (OR = 2.00–2.43; all p ≤ 0.0001). The odds of breaking the fast due to hypoglycemia (OR = 2.25, 2.84, and 3.13) or hyperglycemia (OR = 2.09, 2.71, and 3.46) increased progressively with the number of microvascular complications (all p ≤ 0.0001). The odds of severe hypoglycemia requiring medical intervention (OR = 1.47 with 1, 1.82 with 2, and 3.50 with three complications; p ≤ 0.05–0.0001) or severe hyperglycemia (OR = 2.94, 3.69, and 6.49, respectively; all p ≤ 0.0001) during Ramadan fasting also increased with the burden of microvascular complications. Neuropathy was consistently associated with increased odds of all outcomes (all p ≤ 0.0001) apart from severe hypoglycemia (p = 0.67).

Conclusion

The presence and overall burden of microvascular complications increase the risk of adverse glycemic events during Ramadan fasting in people with T2D. Pre-Ramadan risk stratification should consider complication burden, especially neuropathy.

Keywords

diabetic nephropathy - diabetic neuropathy - diabetic retinopathy - hyperglycemia - hypoglycemia - microvascular complications - Ramadan fasting - risk assessment - type 2 diabetes

Authors' Contribution

M.H., R.A.M., and G.P. were responsible for the concept of the article and led the project. All authors have written parts of and have reviewed the whole manuscript.


Compliance with Ethical Principles

The study received ethics approval from the Dubai Health Authority (DHA: DSREC-04/2002_29).


* These authors are the joint first authors.




Publication History

Article published online:
21 November 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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