Ramadan fasting in diabetic patients: When is fasting not advisable in a person with diabetes?

Ramadan Fasting is one of the five pillars of Islam, but there is a clear exemption in holy Qur'an for those who are temporarily or permanently ill. Diabetes Mellitus is one of the most prevalent chronic illnesses globally; it is associated with metabolic risks that might be augmented with fasting. In spite of this risk many Muslims prefer to fast considering not fasting is a great sin and shameful. Defining the situations when fasting is not advisable in a diabetic patient is an important issue which has to be clearly determined on bases of solid evidence whenever possible. The recommendations have to be agreed between experts of physicians and Islamic Religion scientists. The advances in diabetes management necessitate continuous updating of the recommendations to match with Islamic legitimacy. The role of healthcare providers is neither recommending nor preventing a patient from fasting, their role is just to explore risks and provide medical advice for safe fasting. This review summarizes previous trials for risk stratifications and recommendations for fasting in diabetic patients.