What does this research mean for the field?

In high-risk patients with type 2 diabetes using insulin or sulfonylureas, glycemic control significantly worsens during Ramadan fasting, and pre-Ramadan Time in Range (TIR) greater than 70% and Glycemia Risk Index (GRI) of 20 or less strongly predict successful fasting. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The study aims to assess the impact of Ramadan fasting on CGM metrics in type 2 diabetes and identify predictors of successful fasting.

June 7, 2026

1959-P: First Real-World Evaluation of CGM Outcomes during Ramadan Intermittent Fasting in Type 2 Diabetes Using the SYAI Sensor

Key Points

The study aims to assess the impact of Ramadan fasting on CGM metrics in type 2 diabetes and identify predictors of successful fasting.
Reviewed pre- and during Ramadan CGM data for 64 participants with type 2 diabetes using insulin and/or sulfonylurea.
Defined a fasting double target based on breaking the fast ≤2 days and achieving Ramadan time in range >70%.
Employed logistic regression to evaluate predictors associated with achieving the fasting double target.
Glycemic control worsened during Ramadan fasting with time in range decreasing from 67.68% to 62.38%, p<0.01.
Only 45% achieved the fasting double target, with significant discrepancies in pre-Ramadan metrics (p<0.01 across various measures).
Pre-Ramadan TIR >70% and GRI ≤20 were strongly associated with achieving the fasting double target.

Abstract

Introduction and Objective: Use of continuous glucose monitoring (CGM) systems during Ramadan fasting is increasing among people with type 2 diabetes (PWT2D). We evaluated changes in CGM metrics from pre- to during Ramadan and whether pre-Ramadan CGM metrics predicted fasting success among high-risk PWT2D who attempted to fast while using the SYAI CGM sensor. Methods: Pre-Ramadan and Ramadan CGM data were reviewed for 64 PWT2D using insulin and/or sulfonylurea (SU) who attempted to fast during Ramadan 2025. Eligible participants had two months of CGM data (pre- and during Ramadan) and sensor active time ≥70%. A composite “fasting double target” was defined as breaking the fast because of diabetes on ≤2 days and achieving Ramadan TIR 70%. Logistic regression was used to identify predictors of achieving the fasting double target Results: Glycemic control worsened from pre- to during Ramadan as follows: time in range (TIR) (67.68 to 62.38%, p0.01); time above range (TAR250) (8.57 to 11.18, p=0.01); Glycemia risk index (GRI) (32.82 to 39.49, p0.01), and average glucose (165.85 to 173 mg/dl, p0.01). No significant changes were noted in TBR, TAR180, or coefficient of variation. Only 45% of PWT2D achieved the fasting double target. Participants who achieved the fasting double target had better pre-Ramadan CGM metrics than those who did not (TIR: 83.68 vs 54.58, p0.01; GRI: 16.25 vs 46.39, p0.01; average glucose: 141.63 vs 185.67, p0.01; GMI: 6.72 vs 7.95, p0.01; and TAR180: 13.66 vs 32.48, p0.01; and TAR250: 1.62 vs 14.25, p0.01). After adjusting for age, sex, employment/insurance status, educational level, age at diabetes diagnosis, and diabetes duration; pre-Ramadan TIR70% and GRI ≤20 were strongly associated with achieving the fasting double target Conclusion: Among high-risk PWT2D using insulin and/or SU, glycemic control worsened during Ramadan fasting. Pre-Ramadan TIR and GRI were strongly associated with successful fasting, highlighting the importance of CGM-guided risk stratification and counseling before Ramadan Disclosure M.E. Al-Sofiani: Speaker's Bureau; Ended; Medtronic, Dexcom, Inc. Research Support; Current; Dexcom, Inc. Research Support; Ended; Medtronic. Speaker's Bureau; Ended; Insulet Corporation, Abbott Diabetes, Sanofi. H. Albalawi: None. S.K. Alharthi: None. F. Alam: None. A.S. Alangri: None. K.H. Aburisheh: None.

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