Impact of BMI on Ramadan fasting in individuals with type 2 diabetes mellitus: Insights from the DaR Global Surveys 2020-2022.
9 affiliations
- 1Department of Medicine, College of Medicine, Taibah University, Almadinah Almunawwarah, KSA.
- 2Diabetes and Ramadan Alliance Chief Science Officer, Egypt.
- 3Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Bangladesh.
- 4Association of Clinical Endocrinologist & Diabetologist of Bangladesh (ACEDB), Bangladesh.
- 5Internal Medicine Department, Fakultas Kedokteran Universitas Bra Wijaya - Dr. Saiful Anwar Hospital, Indonesia.
- 6Saifee Hospital, Sir H.N. Reliance Foundation Hospital, India.
- 7Dubai Hospital, DHA, United Arab Emirates.
- 8Gulf Medical University, United Arab Emirates.
- 9Postgraduate Diabetes Education, Cardiff University, UK.
Abstract
Fasting during the holy month of Ramadan is a central religious practice for Muslims worldwide, including individuals living with type 2 diabetes mellitus (T2DM). Managing diabetes during prolonged fasting presents significant clinical challenges, particularly balancing glycemic control and preventing complications such as hypoglycemia. The body mass index (BMI) is a widely used surrogate marker for metabolic status and may significantly influence the physiological response and tolerance to fasting in individuals with T2DM. However, data are limited regarding the relationship between BMI and fasting experiences among diabetic individuals in diverse Muslim-majority populations. This study used data from the Diabetes and Ramadan (DaR) Global Survey, conducted via SurveyMonkey, to examine the associations between BMI and fasting-related outcomes among adults with T2DM in Muslim-majority countries. The findings may support more personalized risk stratification and clinical guidance for safe fasting practices in this population. Using a specifically designed SurveyMonkey questionnaire, Muslim individuals with T2DM were surveyed in several countries in different geographical regions and stratified by BMI. Basic demographic, clinical, and fasting-related data were collected and analyzed using descriptive and inferential statistics to explore differences between subgroups. Among 6530 participants, 42.4% were overweight and 37.7% were obese, and obesity was more prevalent in females and the Gulf region. Individuals with obesity were younger and had a slightly longer duration of diabetes. Glycemic control (mean HbA1c ∼ 8.2-8.4%) was similar among BMI groups. Obesity was associated with higher systolic blood pressure, hypertension, hyperlipidemia, and microalbuminuria. Pharmacologic management patterns varied little, although use of GLP-1 receptor agonists was greater among individuals with obesity, and Ramadan fasting intentions and practices remained consistent across BMI groups. Self-reported hypoglycemia and hyperglycemia rates were comparable, although overweight participants had higher rates of emergency visits (p = 0.01). Most participants received Ramadan-specific diabetes education, but self-monitoring of blood glucose adherence varied. Individuals with T2DM in all BMI categories were able to fast safely during Ramadan, with no significant differences in fasting behavior or adverse events. Despite a higher burden of cardiometabolic comorbidities among obese participants, glycemic control and complication rates during fasting were comparable. These findings highlight the importance of structured education and individualized care for supporting safe fasting among people with diabetes, regardless of BMI.
Related
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BibTeX
@article{alzaman2026impact,
title = {{Impact of BMI on Ramadan fasting in individuals with type 2 diabetes mellitus: Insights from the DaR Global Surveys 2020-2022.}},
author = {Naweed Alzaman and Mohamed Habib and Farid Uddin and Rulli Rosandi and Shehla Shaikh and Mohamed Hassanein},
journal = {Journal of Taibah University Medical Sciences},
year = {2026},
month = oct,
doi = {10.1016/j.jtumed.2026.10.002},
url = {https://europepmc.org/article/MED/42999643},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Impact of BMI on Ramadan fasting in individuals with type 2 diabetes mellitus: Insights from the DaR Global Surveys 2020-2022.
AU - Naweed Alzaman
AU - Mohamed Habib
AU - Farid Uddin
AU - Rulli Rosandi
AU - Shehla Shaikh
AU - Mohamed Hassanein
PY - 2026
DA - 2026/10/30
JO - Journal of Taibah University Medical Sciences
DO - 10.1016/j.jtumed.2026.10.002
UR - https://europepmc.org/article/MED/42999643
AB - Fasting during the holy month of Ramadan is a central religious practice for Muslims worldwide, including individuals living with type 2 diabetes mellitus (T2DM). Managing diabetes during prolonged fasting presents significant clinical challenges, particularly balancing glycemic control and preventing complications such as hypoglycemia. The body mass index (BMI) is a widely used surrogate marker for metabolic status and may significantly influence the physiological response and tolerance to fasting in individuals with T2DM. However, data are limited regarding the relationship between BMI and fasting experiences among diabetic individuals in diverse Muslim-majority populations. This study used data from the Diabetes and Ramadan (DaR) Global Survey, conducted via SurveyMonkey, to examine the associations between BMI and fasting-related outcomes among adults with T2DM in Muslim-majority countries. The findings may support more personalized risk stratification and clinical guidance for safe fasting practices in this population. Using a specifically designed SurveyMonkey questionnaire, Muslim individuals with T2DM were surveyed in several countries in different geographical regions and stratified by BMI. Basic demographic, clinical, and fasting-related data were collected and analyzed using descriptive and inferential statistics to explore differences between subgroups. Among 6530 participants, 42.4% were overweight and 37.7% were obese, and obesity was more prevalent in females and the Gulf region. Individuals with obesity were younger and had a slightly longer duration of diabetes. Glycemic control (mean HbA1c ∼ 8.2-8.4%) was similar among BMI groups. Obesity was associated with higher systolic blood pressure, hypertension, hyperlipidemia, and microalbuminuria. Pharmacologic management patterns varied little, although use of GLP-1 receptor agonists was greater among individuals with obesity, and Ramadan fasting intentions and practices remained consistent across BMI groups. Self-reported hypoglycemia and hyperglycemia rates were comparable, although overweight participants had higher rates of emergency visits (p = 0.01). Most participants received Ramadan-specific diabetes education, but self-monitoring of blood glucose adherence varied. Individuals with T2DM in all BMI categories were able to fast safely during Ramadan, with no significant differences in fasting behavior or adverse events. Despite a higher burden of cardiometabolic comorbidities among obese participants, glycemic control and complication rates during fasting were comparable. These findings highlight the importance of structured education and individualized care for supporting safe fasting among people with diabetes, regardless of BMI.
SN - 1658-3612
ER -