SAT-837 - Supporting Safe Fasting: Endocrinologists' Approaches to Diabetes Care and Complications in Ramadan

We conducted a national survey of Canadian endocrinologists to assess awareness of Ramadan-related diabetes guidelines, clinical practices, and perceived barriers to equitable care. The survey was emailed to 350 endocrinologists; 42 responded, primarily from Ontario (43%) and British Columbia (34%), with additional respondents from Quebec, Alberta, and Saskatchewan.

Nearly all respondents (98%) correctly identified that Ramadan involves abstaining from food & drink from dawn to sunset, though only 49% recognized that oral or swallowed medications are avoided during fasting hours. While acknowledging that Muslim patients with diabetes are religiously exempt from fasting, respondents noted that many still choose to fast and viewed their role as supporting safe fasting.

Most endocrinologists (79%) were aware of the Canadian Guidelines for Diabetes Management in Ramadan, and 95% had discussed Ramadan fasting with patients, primarily those with type 2 diabetes (82%) but also with type 1 diabetes (66%). Just over half (56%) reported using the guidelines to inform care. Medication adjustments were common (92%), most frequently involving reductions in long-acting insulin (96%), with a mean dose reduction of 30% (±19%). Few adjusted mealtime insulin beyond advising administration only with meals; 24% reduced doses. About half (54%) modified insulin pump settings. For non-automated pumps, basal rates were commonly reduced (67%), while insulin-to-carbohydrate ratios and sensitivity factors were rarely adjusted. For automated pumps, most respondents made no changes to basal rates (81%), carbohydrate ratios (87%), or sensitivity factors (88%). Eighty-four percent modified oral antihyperglycemic therapy, most commonly reducing or discontinuing secretagogues (97%) & SGLT2 inhibitors (43%). All continued DPP-4 inhibitors, while most continued metformin (82%) and GLP-1 receptor agonists (78%) without dose changes.

Few reported Ramadan-related complications among patients with diabetes (Type 1: 16%; Type 2: 13%), with hypoglycemia being the most commonly reported complication. Nearly all (97%) agreed that continuous glucose monitoring improves fasting safety through early hypoglycemia detection.

Overall, awareness of Ramadan-specific diabetes guidelines is high, but implementation remains inconsistent. Greater emphasis on individualized, culturally sensitive care is needed. Ongoing work includes incorporating perspectives from family physicians and patients to identify barriers and improve equitable diabetes care during Ramadan.

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