Fasting in Ramadan is obligatory for all adult, healthy and sane Muslims.

There are proven metabolic benefits of Ramadan fasting in healthy as well as diabetes patients.

Given the propensity of acute metabolic derangements and medicine-related side-effects, patients with diabetes can be at significant health risk by fasting.

A pre-Ramadan risk stratification is crucial for diabetes patients, to guide and support the patients with informed decision-making.

High- to very high-risk patients are advised not to fast but if they choose to fast, they should be supported and monitored closely.

Pre-Ramadan assessment and education have been shown to improve the fasting experience of patients with diabetes.

There is emerging evidence that newer technologies, such as insulin pump therapy, continuous glucose monitoring and hybrid closed-loop systems, can help type 1 diabetes patients and some evidence that flash glucose monitoring can help high-risk type 2 diabetes patients, fast with fewer complications.

In the current pandemic, patients in the low- or moderate-risk category, who are exposed to patients with confirmed COVID-19, are safe to fast as long as they are asymptomatic. Those who develop symptoms whilst fasting should be advised to break the fast.