Ramadan fasting as an intermittent fasting method: effects on sleep patterns and exercise in diabetic and non-diabetic adults in Tabuk, Saudi Arabia – a cross-sectional study

Ramadan is among the five major pillars of Islam, during which adults abstain from eating and drinking from dawn to sunset. Some individuals with diabetes mellitus are exempt from fasting due to potential health risks. However, many choose to fast. We investigated Ramadan fasting practices, lifestyle factors, sleep patterns, and fasting-related risk among patients with diabetes and those without diabetes. This cross-sectional study was conducted among 204 participants with and without diabetes in Tabuk, Saudi Arabia, from March to April 2025. A structured questionnaire evaluating demographic factors, the International Diabetes Federation risk score (IDFRS) for fasting risk, sleep patterns, and exercise was used. Among the 204 participants, 65.7% were women, the mean age was 33.69±11.94 years, 25.5% had diabetes, and 59.8% reported sleeping <6 hours per night during Ramadan. Among participants with diabetes, 65.4% reported hypoglycemia, 15.4% reported hospital admission during Ramadan, and 73.2% were classified as having moderate/high fasting risk according to the IDFRS. Participants with diabetes were older than those without diabetes (38.2±15.2 vs. 32.5±10.3 years, p=0.034). Multivariable logistic regression assessing factors associated with fasting showed that older age (adjusted OR 0.93, 95% CI 0.87–0.99; p=0.034) and obesity (adjusted odds ratio 0.19, 95% confidence interval 0.04-0.95; p=0.043) were associated with lower odds of Ramadan fasting. Individuals with diabetes experienced fasting-related risks, including hypoglycemia and hospital admission. These findings highlight the importance of individualized assessment, education, and risk-based guidance for people with diabetes who choose to fast during Ramadan.