Ramadan Fasting in Children and Adolescents with Diabetes: A Narrative Review and Practical Clinical Guidance

Ramadan fasting is a deeply meaningful religious practice for many Muslim families, yet it creates important clinical challenges for children and adolescents living with diabetes. Although prepubertal children and individuals with chronic illness are religiously exempt from fasting, many older children and adolescents choose to fast for spiritual, cultural, and social reasons. The available pediatric evidence is limited and is largely derived from observational studies, small cohorts, and real-world diabetes technology reports. Nevertheless, consistent themes have emerged. Fasting may be feasible for selected adolescents with stable glycemic control, reliable glucose monitoring, structured pre-Ramadan education, family supervision, and ready access to diabetes care. The most frequent acute complication is mild to moderate hypoglycemia, often occurring in the late afternoon before breaking the fast (iftar), whereas severe hypoglycemia and diabetic ketoacidosis are uncommon in carefully supervised cohorts. Continuous glucose monitoring, conventional insulin pump therapy, and automated insulin delivery systems can improve recognition of glucose excursions and may support safer fasting, but they do not eliminate the need for individualized clinical judgment. Pre-Ramadan HbA1c, prior hypoglycemia, ability to monitor glucose, adherence to insulin therapy, and family support remain central determinants of fasting safety. This narrative review summarizes the current pediatric evidence, highlights practical risk stratification, and proposes clinical guidance for healthcare professionals caring for children and adolescents with type 1 or type 2 diabetes who wish to fast during Ramadan.