Fasting & Medication

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Barriers are not preferences

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Meaning, religious or not

Hope, purpose, faith, relationships and identity can be part of the conversation if the person wants. None is assumed.

• Physician or nurse: Health risks, medicine changes and follow-up.
• Pharmacist: Medicine timing, doses and alternatives during the fast.
• Dietitian: Meals and fluids before and after fasting hours.
• Diabetes or specialist educator: Home checks and what to do with the results, where such roles exist.
• Chaplain or spiritual-care provider: Meaning, distress, hope and relationships, for people of any faith or none.
• Interpreter or communication specialist: Language and communication support so the person's own words come through.
• People the person chooses: Family, friends, or a community or faith contact, only if the person wants them. Never assumed safe, available or wanted.

Roles, titles and training differ by country and service. Not every role exists everywhere.

A small set of places chosen for contrast, not a ranking or a representative survey: Multi-country, United Kingdom, Morocco, Bangladesh, Ethiopia, Australia, Singapore, Germany, Canada. Each example states what its source establishes and what it does not. Policy on paper is not proof that a service is available.

Abstract only:

Read from the abstract. The full paper may add or qualify this.

Service as described:

Describes a service when the source was written. Whether it still runs is not verified.

Guidance, not outcomes:

Shows what is written or recommended. It does not show that it is followed or what results.

Place from authors:

The place is taken from the authors' affiliations, not from where data were collected.

• Multi-country · Measured outcome · 2023

  In a randomized trial across five Muslim-majority countries, people with type 2 diabetes who received pre-Ramadan assessment, Ramadan-focused education and adjusted glucose-lowering treatment had lower odds of severe hypoglycemia than those given usual care (OR 0.2, interval 0.1 to 0.8).

  Limits: Abstract only

  What others could learn: Pre-fast risk assessment, fast-specific education and a medicine review can be planned as one sequence before the fast. In this trial the bundle was followed by fewer severe lows than usual care.

  Conditions, limits and source

  Conditions that matter:

  Clinicians who know the recommendations, time before the fast for assessment and education, and the ability to change glucose-lowering medicines. The abstract does not describe staffing, visit timing or follow-up contacts.

  Cannot be inferred:

  Which component drove the effect. Results for type 1 diabetes, other conditions, or people not planning to fast. Results for any single country. Effects beyond the Ramadan month. Independent replication.

  Limits:

  Abstract only; full text not retrieved. Countries not named in the abstract. 23% of eligible people declined; 12.6% (intervention) and 8.7% (control) were lost to follow-up. The trial tests the authors' own recommendations, so independence is limited. The intervention bundles assessment, education and drug changes, so parts cannot be separated.

  Source: Diabetes/Metabolism Research and Reviews (Ibrahim M et al.); abstract via PubMed, Optimizing Ramadan fasting: A randomised controlled trial for people with type 2 diabetes during Ramadan applying the principles of the ADA/EASD consensus (Abstract, Results). Where: Multi-country (five Muslim-majority countries, not named in the abstract). Population: People with type 2 diabetes who took part in Ramadan studies (506 enrolled; 452 with outcome data). Published 2023-01-11; retrieved 2026-10-11.

• United Kingdom · Measured outcome · 2020

  In a telephone survey of 829 Muslim adults with type 2 diabetes in Tower Hamlets, London, after Ramadan 2020, 334 had discussed fasting with a health professional; 198 were advised not to fast, and 171 of them did not.

  What others could learn: Most people who got individual advice not to fast followed it (171 of 198; 17 fasted some days). Discussion rates were lower than in 2016; the authors point to poorer access to advice and note that community Ramadan education classes were cancelled. A clinic can ask each person with diabetes about fasting plans early, record the advice and the decision, and keep a route for those who decide to fast anyway.

  Conditions, limits and source

  Conditions that matter:

  Per the paper: Ramadan-focused education classes in community settings had run for years in the borough; surveyors worked in English and Bengali; primary care registers supported random sampling. The authors suggest planning at least six weeks before Ramadan.

  Cannot be inferred:

  Not representative of other UK areas or of UK Muslims overall. Not proof that advice caused non-fasting. Findings come from a COVID-19 year. Fasting outcomes are self-reported.

  Limits:

  Self-reported recall. 73.9% of people contacted took part. Community Ramadan education classes were cancelled and primary care access was curtailed in 2020, so discussion rates were lower than in 2016. People advised not to fast differed from those allowed to fast (older, more insulin use, more cardiovascular or renal disease), so advice and behavior cannot be compared causally. The abstract gives 40.2% and the Results text 40.1% for those who discussed fasting; counts agree.

  Source: Diabetes Research and Clinical Practice (Khan H, Chowdhury A, Lasker SS, Chowdhury TA), The effect of COVID-19 on Ramadan fasting in people with diabetes in East London 2020: The East London diabetes in Ramadan survey (Abstract, Results; full text Results (PMC7834807)). Where: United Kingdom (Tower Hamlets, London). Population: Muslim adults with type 2 diabetes, randomly drawn from primary care registers. Published 2020-09-28; retrieved 2026-10-11.

• Morocco · Measured outcome · 2021

  In a Casablanca hospital, 61 adults with type 2 diabetes followed by telemedicine in Ramadan 2020 (lockdown) had a smaller HbA1c fall than the same patients followed in person in 2019; the authors say telemedicine can supplement conventional care.

  What others could learn: A fixed contact schedule can cover everyone with diabetes in Ramadan, including people who do not fast: a risk consultation before, a check during, a review after. Remote visits may work as an addition to in-person care when travel is restricted; the authors point to monitoring weight and acute complications such as hypoglycemia. In this study they did not match in-person care on HbA1c.

  Conditions, limits and source

  Conditions that matter:

  A hospital team that systematically follows every patient through the month, a telemedicine platform, consent, and risk classification by international guidelines. Patients needed devices and connectivity (not described in detail).

  Cannot be inferred:

  Whether telemedicine performs differently outside lockdown. Results for primary care or for people without devices. Causation. Any national pattern for Morocco.

  Limits:

  Small, single-center study with no concurrent control. The two Ramadans differ: 2020 coincided with a national lockdown that the authors say may have affected diet and activity. Confounders were not all collected. The abstract and full text give different p-values for some comparisons (hypoglycemia 0.09 vs 0.06; fasting interruption 0.012 vs 0.62), so only the HbA1c finding and the authors' conclusion are used here.

  Source: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy (Motaib I et al.), Diabetes During the Fasting Month of Ramadan: Is Telemedicine as Efficient as Conventional Follow-Up? Results from a Moroccan Comparative Study (Conclusion section (PMC8435613)). Where: Morocco (Casablanca). Population: Adults with type 2 diabetes (median age 63), whether or not they fasted; 41% fasted. Published 2021-09-08; retrieved 2026-10-11.

• Bangladesh · Service described in 2020

  A Dhaka pediatric diabetes center reports that nine young people with type 1 diabetes on insulin pumps fasted in Ramadan 2020 with support from the team's telemedicine service.

  What others could learn: Per the Methods: contact began about a month before Ramadan; education covered patients and caregivers; doses were changed for the new meal times; patients were told to call for dose changes or after any low or high; doses were reviewed after week one, then weekly or sooner. A clear call-in route and a set review rhythm were the support described.

  Conditions, limits and source

  Conditions that matter:

  Insulin pump technology (more than 20 pump users at the center), a dedicated pediatric team and program, caregiver involvement, and phone access. Patients had prior Ramadan education.

  Cannot be inferred:

  Safety for people without pumps, with type 2 diabetes, or without a specialist team. Anything beyond nine patients in one year. Whether the telemedicine element, rather than the pumps or prior education, mattered.

  Limits:

  Nine patients, no comparison group, selected as pump users who contacted the team about a month before Ramadan and had been educated for years. The authors report mild hypoglycemia in three patients (who broke the fast) and some hyperglycemia, so 'safely' means no severe hypoglycemia, no ketoacidosis and no admissions.

  Source: Journal of Diabetes Investigation (Zabeen B et al.), Young people with type 1 diabetes on insulin pump therapy could fast safely during COVID-19 pandemic Ramadan: A telemonitoring experience in Bangladesh (Abstract, last sentence; protocol in full text Methods, 'Protocol' (PMC8169351)). Where: Bangladesh (Dhaka). Population: Nine young people with type 1 diabetes using insulin pumps (mean age 19.3), with caregivers. Published 2020-12-10; retrieved 2026-10-11.

• Ethiopia · Measured outcome · 2026

  At one Addis Ababa hospital, 68 adults with type 2 diabetes not using insulin who kept the 15-day Assumption Fast saw mean fasting glucose fall 19.56 mg/dL; 91.2% were in target range at the end, versus 67.6% at baseline.

  What others could learn: Fasts outside Ramadan also reach diabetes clinics. In Table 2, people who had stopped a previous fast named medication (4), fear of hypoglycemia (5) and fatigue (6) among the reasons. A clinic can ask which fast, which days and what medicines are taken during it, and plan glucose and blood pressure checks, as it would for Ramadan. This study did not record medication changes.

  Conditions, limits and source

  Conditions that matter:

  Clinic follow-up during the fast, glucometer and blood pressure measurement at clinic or home, trained general practitioners as data collectors, and a questionnaire translated into Amharic.

  Cannot be inferred:

  That fasting improves glucose or blood pressure in general. Effects on people using insulin or sulfonylureas, which were not separated. Any other Orthodox fast or setting. What advice patients received.

  Limits:

  No non-fasting control group. Single center, convenience sample, short follow-up. The authors state that physical activity, calorie intake, drug therapy and nutrient composition were not measured or controlled. Insulin users were excluded, so the results say nothing about the group with the highest hypoglycemia risk. Authors call for multicenter trials.

  Source: BMC Endocrine Disorders (Gichamo FG et al.), Changes in glycemic control and blood pressure during the Assumption Fast in Ethiopian Orthodox Christians with type 2 diabetes mellitus: a prospective observational study (Discussion, first paragraph (PMC12895756); participant reasons for stopping a previous fast in Table 2). Where: Ethiopia (Addis Ababa). Population: Adults with type 2 diabetes who were Ethiopian Orthodox Christians fasting the Assumption Fast; insulin users, pregnant or lactating women and people on steroids excluded. Published 2026-01-30; retrieved 2026-10-11.

• Australia · Reported experience · 2022

  In comments from 88 Muslim patients at a Melbourne tertiary hospital around Ramadan 2021, patients' past experiences with health professionals shaped whether they sought advice about their medicines for Ramadan or dismissed advice and self-managed, sometimes inappropriately.

  Limits: Abstract only

  What others could learn: Ask what a person has changed or plans to change about their medicines for the fast, and how earlier encounters with health professionals went. The abstract reports wide variation in what people believe breaks the fast, so the conversation can start from the person's own view. It links past relationships with health professionals to whether patients sought advice.

  Conditions, limits and source

  Conditions that matter:

  A hospital pharmacy team led the work; patients came from many countries and languages (interpreter use not stated in the abstract); admission and discharge are natural points to ask.

  Cannot be inferred:

  How common medication changes were, or how often they caused harm. Views of Muslim patients outside hospital or outside this city. A tested way to improve disclosure.

  Limits:

  Abstract only; full text not retrieved. Data are free-text comments to a questionnaire, not interviews. Single hospital; people were inpatients or recently discharged. The abstract does not say how many altered medicines or with what result.

  Source: Australian Health Review (To TP et al.); abstract via PubMed, Qualitative exploration of Australian Muslim patients' perceptions and experiences surrounding medication management during Ramadan (Abstract, Results). Where: Australia (Melbourne, Victoria). Population: Muslim patients hospitalized during or shortly before Ramadan 2021, born in many countries, with varied medical and surgical conditions. Published 2022-06; retrieved 2026-10-11.

• Singapore · Service described in 2021

  A Singapore review published online in 2021 reports that a computerized system to alert physicians or schedule patients for pre-Ramadan assessment was available in certain polyclinics.

  Limits: Service as described

  What others could learn: A prompt in the health record can trigger the question about fasting plans months ahead, at routine visits, with 2 to 3 months allowed for assessment and education. The review lists face-to-face, group and telemedicine delivery, and Ramadan sessions in community settings run by public bodies, faith-based groups and non-profits.

  Conditions, limits and source

  Conditions that matter:

  Per the review: polyclinics that serve a large share of people with diabetes, a record system able to alert or schedule, community partners for education, and a preference some patients have for culturally similar care teams in a minority-Muslim country.

  Cannot be inferred:

  That the alert system improves outcomes. Its current coverage or use. Practice in private clinics. That other countries can add such a prompt without local IT and staffing.

  Limits:

  Narrative, not systematic. Does not report how many polyclinics have the system, how often it is used, or any outcome. The authors say it needs enhancement for comprehensive patient selection and wider availability. Describes practice as of publication. The review also contains statements on religious rulings, which are not used here.

  Source: Singapore Medical Journal (Zainudin SB et al.), Preparing Muslims with diabetes mellitus for Ramadan fasting in Singapore: a clinical approach and review of current practice (Section 'Pre-Ramadan period', third paragraph (PMC9815170)). Where: Singapore. Population: People with diabetes in Singapore who intend to fast in Ramadan. Published 2021-04-19; retrieved 2026-10-11.

• Germany · Measured outcome · 2018

  In a survey of 116 Muslim women in two Mainz obstetric wards (pregnant or recently delivered), two women said their doctor had raised Ramadan proactively, and 73% of the professionals consulted had advised against fasting.

  What others could learn: Few women were asked first, and about half of those who fasted did not discuss it with a professional. A routine prenatal question about Ramadan plans, asked of everyone and in the woman's language, could reduce reliance on the patient to start the conversation. The authors also note counseling should reach women who do not fast, because household routines and eating change.

  Conditions, limits and source

  Conditions that matter:

  Interviews were held in the woman's language when possible (two research assistants spoke Arabic and Turkish). Prenatal contacts with gynecologists and midwives are the setting the authors target for counseling.

  Cannot be inferred:

  Not representative of Germany or of Muslim women in Germany. Says nothing on pregnancy outcomes or on which advice is correct. A single Ramadan; fasting hours differ across years.

  Limits:

  One city, two wards, Ramadan 2016 only. The authors reached about half of the eligible women; language barriers and early discharge were main reasons. Women were identified as Muslim by registration form or by name. Self-reported. The authors caution against generalizing across years and countries. Advice reported varied, from discouraging fasting to leaving the choice to the woman.

  Source: Geburtshilfe und Frauenheilkunde (Leimer B et al.), Ramadan Observance during Pregnancy in Germany: a Challenge for Prenatal Care (Results, 'Advice of gynecologists and midwives' (PMC6059869)). Where: Germany (Mainz). Population: Pregnant Muslim women and new mothers, interviewed in obstetric wards; 43% fasted at least one day in Ramadan 2016. Published 2018-07-25; retrieved 2026-10-11.

• United Kingdom · Guidance · 2021

  A 2021 UK-authored practical guide says solid organ transplant recipients who wish to fast should have a risk assessment, ideally 3 months before Ramadan, and may need medication changes plus graft and electrolyte monitoring.

  Limits: Abstract only · Guidance, not outcomes · Place from authors

  What others could learn: A transplant team can open the fasting conversation about 3 months ahead, agree with the person which medicine timings and blood tests need to change, and give sick-day rules and instructions on when to end a fast. This extends fasting care beyond diabetes.

  Conditions, limits and source

  Conditions that matter:

  Per the abstract: lead time before Ramadan for assessment; access to tests of graft function and electrolytes; immunosuppression doses about 12 hours apart with little time variation; clinicians willing to discuss risk; fasting hours that differ by latitude and season.

  Cannot be inferred:

  Does not show that fasting is safe or unsafe for any person or organ type; not an official national guideline; says nothing about outcomes after the tool is used; not a statement of what any religion requires.

  Limits:

  Abstract only: the publisher does not allow XML full-text download, so the decision tool and its tables were not read. Review authored by clinicians; the abstract does not state endorsement by a professional body or national program. The abstract says all studies of fasting in transplant recipients came from the Middle East and North Africa, where fasting averages 12 to 14 hours. The risk tiers are borrowed from a diabetes framework; they are not reproduced here and were not checked against transplant outcome data.

  Source: Clinical Medicine (Malik S, Hamer R, Shabir S, et al.); Royal College of Physicians, Effects of fasting on solid organ transplant recipients during Ramadan - a practical guide for healthcare professionals (Abstract). Where: United Kingdom (author affiliations; the studies reviewed come from the Middle East and North Africa). Population: Adult solid organ transplant recipients (the keywords list heart, kidney, liver and lung) who ask clinicians about fasting during Ramadan. Published 2021-09; retrieved 2026-10-11.

• Canada · Guidance · 2019

  Diabetes Canada's 2019 position statement on fasting during Ramadan with diabetes was written by an expert forum with an informed patient participating. Religious leaders endorsed it and provided letters of support.

  Limits: Abstract only · Guidance, not outcomes

  What others could learn: A guideline process can include a patient participant and outside endorsement. The abstract says this statement did both; it does not say how either shaped the recommendations. It also notes that most prior research came from Middle Eastern or South Asian countries and that work hours, fasting hours, medicines and glucose monitoring differ in Canada.

  Conditions, limits and source

  Conditions that matter:

  Per the abstract: an expert forum with an international member, independent external review by Diabetes Canada scientific leadership and Canadian providers, a patient participant, letters of support from religious leaders, and endorsement by the national diabetes organization.

  Cannot be inferred:

  Does not show that the statement changed practice or outcomes in Canada; does not state its recommendations; not evidence about other Canadian guidelines; not a statement of what any religion requires.

  Limits:

  Abstract only; publisher full text was not retrieved, so the recommendations themselves are neither quoted nor assessed. The abstract describes an expert forum of seven Canadian experts and one international expert, independent external review, and endorsement by Diabetes Canada. It does not say how the informed patient was chosen, which leaders endorsed it, or whether the statement is still current. Process description, not an evaluation of use or outcomes.

  Source: Canadian Journal of Diabetes (Bajaj HS, Abouhassan T, Ahsan MR, et al.); Diabetes Canada, Diabetes Canada Position Statement for People With Types 1 and 2 Diabetes Who Fast During Ramadan (Abstract). Where: Canada. Population: Adults with type 1 or type 2 diabetes who intend to fast during Ramadan, and their health-care providers. Published 2019-02; retrieved 2026-10-11.

• Multi-country · Measured outcome · 2023

  A 2023 Cochrane review of 17 randomized trials (5,359 participants) found no clear evidence of benefits or harms of interventions for Muslims with type 2 diabetes who fast during Ramadan.

  Limits: Abstract only

  What others could learn: Evidence for any single pre-Ramadan intervention in type 2 diabetes is thin. A clinic can treat medicine changes and education as shared decisions with the person, say that the evidence is uncertain, record the plan and check how the fast went.

  Conditions, limits and source

  Conditions that matter:

  Per the abstract: trials had a four-week study duration and at least four weeks of follow-up. Comparisons were drug classes against sulfonylureas, insulin analogues against biphasic insulin, telemedicine, Ramadan-focused education and drug dose reduction. Low-certainty evidence suggested that DPP-4 inhibitors, SGLT-2 inhibitors and GLP-1 analogues may reduce hypoglycemia compared with sulfonylureas. Most other comparisons were very uncertain.

  Cannot be inferred:

  Does not show that any intervention is safe or unsafe for a given person; not guidance on which medicine to use; death, quality of life and severe hypoglycemia were rarely measured; says nothing about type 1 diabetes or other conditions; not a statement of what any religion requires.

  Limits:

  Abstract only; the Cochrane Library host was blocked, so the full review was not read. The abstract says all 17 trials had at least one high-risk domain for risk of bias and that certainty was low to very low. Searches ended 29 June 2022. It does not name the countries or give participants' ages. Each comparison rests on one to four trials.

  Source: Cochrane Database of Systematic Reviews (Lee SWH, Chen WS, Sellappans R, et al.), Interventions for people with type 2 diabetes mellitus fasting during Ramadan (Abstract, conclusion). Where: Multi-country (17 trials; countries not named in the abstract). Population: Muslims with type 2 diabetes who fasted during Ramadan in the included trials. Published 2023-07-12; retrieved 2026-10-11.

• United Kingdom · Guidance · 2021

  A 2021 UK-authored review says people with chronic kidney disease who wish to fast in Ramadan should have a risk assessment, ideally within a month beforehand, and may need medication changes and monitoring.

  Limits: Guidance, not outcomes · Place from authors

  What others could learn: A kidney team can open the fasting conversation about a month ahead, agree which medicines and blood tests need to change, and give sick-day rules and instructions on when to stop a fast. Per the full text, people on hemodialysis or peritoneal dialysis fall in the very high risk tier, with a select group who may fast after individual assessment.

  Conditions, limits and source

  Conditions that matter:

  Per the review: about a month of lead time before Ramadan; access to tests of kidney function and electrolytes; up-to-date education on sick-day rules before the fast starts; clinicians willing to discuss alternatives to fasting; fasting hours that vary by latitude and season.

  Cannot be inferred:

  Does not show that fasting is safe or unsafe for any person or stage of kidney disease; not an official national guideline; says nothing about outcomes after the tool is used; not a statement of what any religion requires.

  Limits:

  Narrative review: PubMed and Google Scholar searches, English-language articles only, mostly observational studies. The authors write that the recommendations came from author consensus based on clinical experience and are informative, not a directive. They also sought consensus from renal physicians and a religious scholar. The risk tiers are borrowed from a diabetes framework and are not reproduced here. Not an official kidney society guideline; no data on use or outcomes.

  Source: Clinical Kidney Journal (Malik S, Bhanji A, Abuleiss H, et al.); Oxford University Press on behalf of ERA-EDTA, Effects of fasting on patients with chronic kidney disease during Ramadan and practical guidance for healthcare professionals (Abstract). Where: United Kingdom (author affiliations). Population: People with chronic kidney disease, including those on hemodialysis or peritoneal dialysis, who ask about fasting during Ramadan. Published 2021-02-05; retrieved 2026-10-11.

• United Kingdom · Guidance · 2020

  Glasgow-based authors of a 2020 guidance article say epilepsy control can deteriorate during Ramadan, possibly through fasting-related changes to adherence to antiseizure drug regimens.

  Limits: Abstract only · Guidance, not outcomes · Place from authors

  What others could learn: A clinic could ask a person with epilepsy how medicine timing and sleep will change during fasting hours, and plan before the fast with the prescriber. Which timings suit which drugs is for the prescriber and the guidance itself.

  Conditions, limits and source

  Conditions that matter:

  Per the abstract: attention to sleep hygiene and to drugs or preparations that show less variation during fasting; fasting that can last up to 20 hours at temperate latitudes in summer.

  Cannot be inferred:

  Does not show how often control worsens, or why, in any group; gives no advice here on changing any drug; not an official guideline; not a statement of what any religion requires.

  Limits:

  Abstract only; the guidance itself was not read because the publisher full text was not retrieved. The abstract gives no data, no source for the statement about deteriorating control and no names of the drugs or preparations discussed. Five authors, four with a Glasgow hospital or university affiliation and one with a Glasgow foundation; no endorsement by a neurology body is stated.

  Source: Epilepsy & Behavior (Mahmood A, Abbasi H, Ghouri N, et al.), Managing epilepsy in Ramadan: Guidance for healthcare providers and patients (Abstract). Where: United Kingdom (author affiliations, Glasgow). Population: Muslim patients with epilepsy who are preparing for Ramadan, and their healthcare providers. Published 2020-06-26; retrieved 2026-10-11.

• The sourced examples include measured outcome, service description, reported experience, guidance. Each quote was matched to the source text; that is not independent expert review.
• The prompts and fictional case are original. They have not been tested with patients, caregivers or clinicians.
• Whether this workflow helps anyone is an open research question.
• Content is in English. Interface translations are not reviewed for this topic.