Abstract
BACKGROUND: Ramadan fasting presents unique challenges for individuals with type 2 diabetes (T2D) due to alterations in diet and medication regimens. This study evaluates the effects of Ramadan fasting on glycemia by utilizing the glycemia risk index (GRI), which integrates both hypoglycemic and hyperglycemic risks into a unified metric, alongside continuous glucose monitoring (CGM) data. In addition, the study examines the correlation between GRI and diabetes therapy-related quality of life (DTR-QOL) to understand the broader impact on patient outcomes. METHODS: An ambispective, one-group pre-post design was employed at a tertiary diabetes treatment center, involving 111 adults with T2D. Data were collected across three periods: one month before Ramadan, during, and one month after. Clinical, metabolic, and glycemic parameters were recorded. The CGM-based calculations included GRI, with its hypoglycemia component (CHypo) and hyperglycemia component (CHyper). The DTR-QOL was measured to evaluate therapy-related quality of life (QoL). RESULTS: During Ramadan, GRI significantly decreased (median = 30.5) compared to before (35.2) and after (37.4; P < .001), indicating improved glycemic stability. Both CHypo and CHyper were significantly reduced during fasting. The %TIR(70-180) increased from 42% before to 66% during (P < .001), accompanied by a notable decrease in glycemic variability. The DTR-QOL scores were high across all domains, reflecting a positive therapy-related QoL (scale score: 78.3 [interquartile range = 75.4-81.3]). No significant differences were observed across GRI zones. CONCLUSIONS: With tailored education and CGM-based monitoring, Ramadan fasting can improve glycemia in individuals with T2D, enhancing GRI and related glycometric parameters for safer, more stable glycemic patterns.