Metabolic outcomes and insulin therapy modifications during Ramadan fasting in children with type 1 diabetes mellitus in low-resource settings

Introduction

Young Muslims with type 1 diabetes mellitus (T1DM) face serious metabolic challenges during Ramadan fasting, particularly hypoglycemia, hyperglycemia, dehydration, and diabetic ketoacidosis (DKA) risks. Data from low-resource settings (LRS) with limited advanced monitoring tools are insufficient despite established guidelines. Aim of the study: This study planned to evaluate metabolic outcomes and insulin modifications among children and adolescents with T1DM during Ramadan fasting in Surabaya, Indonesia. Material and methods: Our cross-sectional study recruited 25 individuals with T1DM aged 7 to 18 years who fasted for at least two weeks during Ramadan 2025. Data were collected via questionnaires and glucose logbooks. Fasting blood glucose (FBG) was measured before, during, and after Ramadan. We also evaluated insulin total daily dose (TDD) and acute complication incidences.