Download PDF
Open Access
CC BY 4.0 · Journal of Diabetes and Endocrine Practice 2026; 09(01): 146-151
DOI: 10.1055/s-0045-1814743
Original Article

Lessons from the Voluntary Shawwal Fasting by People with Type 2 Diabetes: Individuals' Characteristics and Implications for Ramadan Fasting

Authors

  • Bachar Afandi

    1   Department of Endocrinology, Tawam Hospital and STMC, Al Ain, United Arab Emirates
    2   Department of Medicine, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates

  • Abdul Jabbar

    3   Department of Diabetes and Endocrinology, Medcare Hospital, Dubai, United Arab Emirates
    4   Department of Medicine, College of Medicine, Mohammed Bin Rashid University, Dubai, United Arab Emirates

  • Mohamed Hassanein 

    4   Department of Medicine, College of Medicine, Mohammed Bin Rashid University, Dubai, United Arab Emirates
    5   Department of Endocrinology, Dubai Hospital, Dubai, United Arab Emirates

Funding and Sponsorship This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Further Information
Also available at
  Permissions and Reprints

Abstract

Background

Fasting during Ramadan for people with type 2 diabetes (T2D) can be challenging and may increase the risk of complications. Short period of voluntary fasting during Shawwal has not been studied. Its prevalence and characteristics remain unclear. We hypothesized that individuals who continue fasting into Shawwal represent a self-selected subgroup with greater fasting resilience and safer Ramadan experiences.

Methods

We analyzed data from the 2020 and 2022 Diabetes and Ramadan (DAR) Global Surveys. Participants with T2D who fasted during Ramadan were divided into two groups: Group 1 (n = 2,845) continued fasting in Shawwal, and Group 2 (n = 6,536) did not. All variables in this analysis reflect only Ramadan experiences, including demographics, self-monitoring of blood glucose (SMBG), treatment use, and fasting-related complications. Findings were summarized descriptively to characterize Ramadan profiles associated with the intention to fast in Shawwal.

Results

Nearly one in three participants (30.3%) reported voluntary Shawwal fasting. Compared with Group 2, Group 1 participants were slightly older (55 ± 11.1 vs. 53.3 ± 11.6 years, p = 0.08) and had longer diabetes duration (12.3 ± 5.2 vs. 10.8 ± 4.9 years, p < 0.01). Hypertension (57.9 vs. 42.9%, p = 0.05) and hyperlipidemia (55.5 vs. 38.5%, p = 0.019) were more commonly reported in Group 1. During Ramadan, individuals who later fasted in Shawwal reported lower frequencies of recurrent hypoglycemia (7.3 vs. 12.1%, p = 0.01), fewer breaks in fasting due to hypoglycemia (50.4 vs. 61.1%, p = 0.03), and higher SMBG adherence (16.8 vs. 10.3%, p = 0.01). Hyperglycemia rates were similar between groups (15.2 vs. 14.3%, p = 0.7). These findings reflect experiences during Ramadan and do not represent Shawwal outcomes.

Conclusion

Voluntary Shawwal fasting was reported by nearly one-third of individuals with T2D who had fasted during Ramadan. Those who intended to fast in Shawwal exhibited distinct Ramadan characteristics, including fewer reported hypoglycemia-related disruptions and slightly greater SMBG adherence. These descriptive observations likely reflect self-selection and prior Ramadan experiences rather than any effect of Shawwal fasting itself. Clinicians should acknowledge voluntary fasting practices such as Shawwal when counseling patients with T2D and reinforce individualized education and SMBG guidance.

Keywords

type 2 diabetes - Ramadan fasting - Shawwal fasting - voluntary fasting - hypoglycemia - hyperglycemia - self-monitoring of blood glucose - diabetes education

Authors' Contributions

All authors contributed toward conception, data collection, writing, and final approval of the manuscript.


Statement of Ethics

This study was based on secondary analysis of previously collected data. No ethical approval was required for this analysis. However, the original study was approved by the Dubai Health Authority Medical Research Ethics Committee, and informed consent was obtained from all participants.




Publication History

Article published online:
24 December 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India