1559-P: Understanding the Experiences, Priorities, and Challenges of People with Type 1 Diabetes during Ramadan Fasting: A Qualitative Focus Group Study

Introduction and Objective: Although people with type 1 diabetes (PWT1D) are exempt from fasting; most choose to fast during Ramadan for religious, emotional, and social reasons. While Ramadan clinical guidelines exist, the patient perspectives and priorities remain underrepresented in these guidelines. Here, we reported the lived experiences, priorities, and challenges of PWT1D during Ramadan fasting Methods: A mixed-methods qualitative focus group workshop was conducted with 16 PWT1D from across Saudi Arabia. Semi-structured discussions explored fasting goals, fears, barriers, facilitators, and the role of digital health. Audio recordings were transcribed, translated, and analyzed using an inductive reflexive thematic analysis. Three researchers independently conducted open coding, followed by iterative development of a coding framework and refinement of themes through consensus Results: Mean age of the study participants and duration of diabetes were 26 and 13 years, respectively. Overall, 93% reported fasting during the last Ramadan. Fasting decisions were shaped by perceived religious commitment, family influence, prior experience, social pressure, and medical advice. Key challenges included post-iftar hyperglycemia, fear of daytime hypoglycemia, risk of diabetic ketoacidosis, fatigue, psychological burden, and embarrassment/guilt when breaking the fast. Although CGMs and insulin pumps have facilitated safer fasting, they did not replace individualized preparation, education, and self-management skills. Pre-Ramadan counseling, family support, and clinician guidance remain key facilitators Conclusion: Ramadan fasting for PWT1D involves complex medical, psychosocial, and religious considerations. Patient priorities extend beyond glycemic control to include other health factors, spiritual fulfillment, and social inclusion. Integrating patient perspectives and priorities into pre-Ramadan care and guidelines may support safer and patient-centered fasting experience 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.