The Efficacy and Risk Stratification of Glycemic Control During Ramadan Fasting: A Review of Continuous Glucose Monitoring and Therapy Management Strategies

Ramadan fasting presents unique challenges for diabetic patients due to prolonged periods of fasting and the associated risks of hypoglycemia, hyperglycemia, and metabolic complications. This review examines the efficacy and risk stratification of glycemic control strategies during Ramadan, with a focus on continuous glucose monitoring (CGM) technologies and tailored therapy management. Advances in CGM systems, including flash, real-time, and hybrid models, have enabled comprehensive monitoring using metrics like time in range (TIR), glucose variability (GV), and glycemic risk indices, which together improve patient outcomes. Pharmacological adjustments, notably in insulin regimens and the application of novel agents such as SGLT2 inhibitors and GLP-1 receptor agonists, combined with lifestyle and dietary modifications, further enhance glycemic stability. Evidence demonstrates reductions in HbA1c and diabetes-related complications with CGM-guided management, while risk stratification models based on CGM data facilitate personalized therapy plans to mitigate adverse events. Challenges remain in patient education and implementation of culturally sensitive care, but emerging technologies and artificial intelligence promise further improvements. The integrated approach outlined herein underscores the importance of combining advanced monitoring, individualized treatment, and risk assessment to safely optimize glycemic control during Ramadan fasting.