Ramadan fasting practices and acute complications among Arab children, adolescents, and young adults with diabetes: a cross-sectional survey.

Introduction: Fasting during Ramadan poses specific challenges for children and adolescents with diabetes and may adversely affect glycemic control and the risk of acute complications. Data on the safety of Ramadan fasting among Arab youth with diabetes and adherence to guideline-based care remain limited. This study aimed to evaluate the experiences of Ramadan fasting among Arab children, adolescents, and youths with diabetes. Methods: In this cross-sectional study, we used an expert-reviewed and pilot-tested questionnaire distributed through social media to recruit a non-probabilistic online convenience sample of children, adolescents, and young adults with diabetes across Arab countries. All demographic, clinical, counseling, and fasting-related outcomes were self-reported. Results: In total, 242 (53.7% female) patients participated in this study. The most common age group was 13-17 years (50.8%), and 95.9% of the patients had type 1 diabetes. Before Ramadan, 11.5% reported diabetic ketoacidosis (DKA), 5.0% reported severe hypoglycemia during the previous 3 months, and 26.0% had hypoglycemia unawareness. Nearly half (45.5%) of the participants reported being permitted to fast by their physicians. During Ramadan, DKA and severe hypoglycemia occurred in 6.2% and 2.5% of the patients, respectively. The median number of completed fasting days was 22 (range 0-30). Older patients (aged 13-25 years) were more likely to be allowed to fast (p = 0.033) and complete more fasting days (p < 0.001). In multivariate regression, older age independently predicted fasting allowance (AOR = 1.951, 95% CI: 1.132 - 3.363, p = 0.016). Multiple daily injections decreased the likelihood of being allowed to fast (AOR = 0.444, 95% CI: 0.230 - 0.860, p = 0.016). The most common cause of fasting interruption was hypoglycemia (67.4%), followed by hyperglycemia (24.8%). A weak positive correlation was observed between pre-Ramadan counseling scores and the number of completed fasting days (Spearman's rho = 0.144; p = 0.025). Conclusion: Almost half of the participating Arab children, adolescents, and young adults with diabetes reported being permitted to fast during Ramadan. Older patients were more likely to be permitted to fast and completed more fasting days, and insulin pump users were more likely to be permitted to fast than those on multiple daily injections. A weak positive association was observed between counseling scores and the number of completed fasting days.