Fasting with type 1 diabetes during Ramadan: Influence of insulin regimen in the DaR 2020 & 2022 global surveys.

Abstract

Fasting during Ramadan presents unique challenges for individuals with Type 1 Diabetes (T1D). This study analyzes the characteristics and fasting experiences of T1D patients based on their insulin regimens including basal-bolus (BB) versus premixed (PM) using data from the 2020 and 2022 Diabetes and Ramadan (DaR) Global Surveys. Participants with T1D were grouped by insulin regimen: BB (N = 1619) and PM (N = 520). Demographics, glycemic control (HbA1c), complications, fasting patterns, glycemic events, and diabetes education were assessed and compared. BB regimens were more commonly used in the Gulf and Middle East, while PM regimens were prevalent in Southeast Asia. Glycemic control and diabetes duration were similar (mean HbA1c: 8.6% BB vs. 8.9% PM). A higher proportion of PM users completed the full 30 days of fasting (43.1% vs. 30.6%; p = 0.03). A larger proportion of BB users fasted during Shawwal (16.5% vs. 5.8%; p < 0.0001). Hypoglycemia (63% BB vs. 31.1% PM) and hyperglycemia (46.1% BB vs. 30.8% PM) were significantly higher in BB users, though hospital visits were similar. PM users had fewer diabetes-related complications overall, with the exception of neuropathy. SMBG was more common among BB users, who also received more extensive and varied education. While BB regimens provide greater flexibility, they are associated with higher glycemic variability during Ramadan. PM regimens may support better fasting adherence and fewer acute glycemic events. These findings highlight the importance of individualized treatment strategies and education to support safe fasting in T1D patients.