Insulin Management for Type 2 Diabetes During Ramadan: A Narrative Review for Clinicians

Objective: Muslims with insulin-dependent type 2 diabetes are at high risk for adverse events while fasting during the month of Ramadan. However, advances in pharmacologic therapy coupled with creative strategies of insulin administration can mitigate complications. This narrative literature review investigates which insulin subtypes are likely to prevent hypoglycemic events and reduce hyperglycemia during the Ramadan fasting season for this high-risk population. Design: Narrative literature review Eligibility Criteria: The following MeSH terms were used: “Diabetes Mellitus, Type 2” and “Insulin,” and the “Text Words”: “Ramadan”, “iftar”, “Muslim fast”, and “religious fast.” The primary focus was on adult, non-pregnant, insulin-dependent type 2 diabetes during Ramadan. Anything beyond this focus was excluded. A total of nine pertinent studies were included for narrative review and analysis. Information Sources: PubMed, EMBASE and Medline. Results: The studies identified suggest long-acting insulins reduce the risk of hypoglycemia, and rapid-acting insulin analogues may improve post-iftar hyperglycemia. Moreover, utilizing flexible glycemic targets during Ramadan is a novel strategy that has demonstrated improved outcomes after the fasting season. Conclusion: Certain insulin subtypes and dosing strategies may be advantageous to use during Ramadan. However, a systematic, comprehensive, and updated review, including a critical appraisal of each original study, is needed to improve clinical care of insulin-dependent type 2 diabetes during Ramadan.