Evolution of the risk concept and assessment tools for diabetes during Ramadan fasting: A narrative review

Table 1 The classically reiterated potential complications (confirmed, disputed and hypothetical) of Ramadan fasting in people with diabetes

Type	Potential complication	Status	Notes
Glycemic	Hypoglycemia	Well-documented	Especially in insulin or sulfonylurea users
Glycemic	Hyperglycemia	Well-documented	May result from feasting and reduced medication adherence
Fluid/electrolyte	Dehydration	Documented	Worsened by hot climates and prolonged fasting hours
Vascular	Thrombosis (complication of dehydration)	Disputed	Suggested link via hemo-concentration, not firmly established
Reproductive	Risk to pregnancy and fetus	Well-acknowledged	Particularly in uncontrolled diabetes or comorbid pregnancies
Metabolic	Diabetic ketoacidosis and hyperosmolar hyperglycemic states	Mixed evidence	Earlier studies reported risk; recent data show inconsistent patterns
Trauma-related	Accidents due to hypoglycemia	Hypothetical	Mostly anecdotal; underreported in clinical trials
Long-term glycemic control	Complacency’s impact on year-round diabetes management	Hypothetical	Proposed risk due to temporary dietary changes and relaxed self-monitoring