Ramadan Fasting Practices and Clinical Morbidity in Nigerian Patients with Diabetes Mellitus

Abstract Fasting during Ramadan is a core religious obligation for Muslims, but it poses significant health risks for individuals with diabetes. This study investigated the morbidity patterns and predictors of fasting intentions among Nigerian Muslims with diabetes. A multicenter study was conducted across seven tertiary hospitals in Nigeria, involving 518 diabetic patients. Data on demographic characteristics, clinical morbidity patterns, and fasting intentions were collected. Logistic regression was used to identify predictors of the fasting intention. The majority of participants (78.0%) intended to fast. Logistic regression revealed that a greater fasting intention was significantly associated with a lower HbA1c (odds ratio [OR] = 0.89, p = 0.014), higher body mass index (BMI) categories (e.g., OR = 3.50 for BMI 25–29.9, p = 0.018), and an estimated glomerular filtration rate <60 mL/min (OR = 0.40, p = 0.005). Impaired frailty and cognitive function were strongly associated with a lesser fasting intention (OR = 0.10, p = 0.003). Sex, age, and other morbidity factors like hypoglycemia history were not significant predictors. Most Nigerian Muslim patients with diabetes intended to fast during Ramadan. Intention was significantly influenced by better glycemic control, higher BMI, impaired renal function, and absence of frailty. These findings highlight the need for targeted pre-Ramadan counseling to support safe fasting, focusing on patients' glycemic control, renal function, and frailty status.