Knowledge, Fasting Practices, and Ramadan-Related Complications Among Adults with Type 1 Diabetes Mellitus in Saudi Arabia: A Cross-Sectional Survey.

PURPOSE: Many individuals with type 1 diabetes mellitus (T1DM) choose to fast during Ramadan despite being at increased risk of fasting-related complications. Understanding patients' knowledge and fasting practices is important to support safer Ramadan fasting. However, data on Ramadan-related knowledge, fasting practices, and complications among adults with T1DM in Saudi Arabia remain limited. This study aimed to assess these factors among adults with T1DM in the Qassim region of Saudi Arabia.

METHODS

A single-center, cross-sectional survey was conducted among adults with T1DM who attended a specialized diabetes center in Saudi Arabia. The questionnaire assessed patient characteristics, Ramadan-related knowledge, pre-Ramadan preparation, insulin management practices, fasting behavior, and self-reported complications. A knowledge score ranging from 0 to 5 was calculated based on five knowledge items.

RESULTS

A total of 69 participants were included, with a median age of 24 years (IQR 21-30) and median diabetes duration of 9 years (IQR 4.5-16.0). Most participants consulted a healthcare provider before Ramadan (68.1%) and received diabetes-specific education (89.9%). Nearly all participants fasted during Ramadan (92.8%), with a median of 27 fasting days. Knowledge levels were high, with 92.8% demonstrating good knowledge and a mean knowledge score of 4.70 ± 0.60. Most participants reported reducing their basal (69.6%) and rapid-acting (55.1%) insulin doses and increasing blood glucose monitoring during Ramadan (65.2%). Despite these practices, hypoglycemia and hyperglycemia were reported by 81.3% and 62.5% of participants, respectively, while 7.8% required hospitalization for diabetic ketoacidosis (DKA). More than two-thirds (70.3%) reported breaking their fast because of diabetes-related complications.

CONCLUSION

Adults with T1DM demonstrated high levels of Ramadan-related knowledge and generally appropriate fasting practices. Nevertheless, fasting-related complications remained common, highlighting the need for additional strategies beyond education alone to improve the safety of Ramadan fasting in this population.