Effect of Whey Protein Consumption on Hypoglycemia Risk in Patients with Type 1 Diabetes Fasting during Ramadan: A Randomized, Crossover Trial

Abstract Fasting during Ramadan presents challenges for people with type 1 diabetes (T1D), particularly regarding hypoglycemia risk. Nutritional strategies such as whey protein (WP) supplementation may support safer fasting. This article assesses the effect of WP supplementation at the predawn meal (Suhoor) on hypoglycemia risk and fasting continuity among patients with T1D during Ramadan fasting. In this randomized, controlled, crossover trial, individuals with T1D planning to fast during Ramadan were recruited and assigned to two study phases: one with WP supplementation at Suhoor and one without. Outcomes were assessed using continuous glucose monitoring (CGM), dietary logs, and pre- and post-Ramadan questionnaires. The primary outcomes were the number of hypoglycemic events and the days fasting was interrupted. Forty-one patients with T1D were randomized; 33 were on multiple daily injections and 8 on continuous subcutaneous insulin infusion. The mean age was 24 ± 4.2 years, with a mean diabetes duration of 14.1 ± 7.3 years; 22 participants (53.7%) were female. Pre-Ramadan glycated hemoglobin was 7.6 ± 1.07%. At baseline, 5 patients (12.2%) were categorized as moderate risk by the DaR (Diabetes and Ramadan Alliance) risk score, and 36 (87.8%) as high risk. WP supplementation was associated with a significant reduction in the number of days on which the fast was broken (0.94 ± 1.25 vs. 1.15 ± 1.33 days; p = 0.008). The timing of reported interruptions of the fast due to hypoglycemia was similar across both weeks, with most occurring during the morning hours. CGM-detected mean hypoglycemia events per patient per week by time of day were 0.7 versus 1.1 post-Suhoor (3–6 a.m.) and 0.3 versus 0.6 pre-Iftar (4–6 p.m.), with p = 0.07 and p = 0.05, respectively. However, overall CGM-detected low events and ambulatory glucose profile metrics (time in range, time below range, glucose management indicator, and glucose variability) did not differ significantly between the two regimens. No severe hypoglycemia, diabetic ketoacidosis, or hospital admissions were reported in either week. In the poststudy survey, 51.2% of participants reported that WP at Suhoor was beneficial, and 68.3% indicated that they would use it again during Ramadan fasting. WP supplementation at Suhoor may reduce hypoglycemia-related fast-breaking in adults with T1D during Ramadan without compromising glycemic safety. These findings support WP as a feasible adjunct to structured fasting plans in T1D. Further, larger multicenter studies are needed.