Factors associated with hypoglycemic or hyperglycemic events during Ramadan among persons with diabetes in Qatar

BACKGROUND: Despite the high prevalence of diabetes in Qatar, Ramadan-related glycemic events remain inadequately characterized. This study examined sociodemographic, clinical and behavioral factors independently associated with hypoglycemic or hyperglycemic events among patients with diabetes during Ramadan in Qatar. METHODS: A retrospective analysis was conducted using routinely collected data from the Qatar Diabetes Association (QDA) Ramadan support program covering three Ramadan seasons (2022-2024). Patients with type 1 or type 2 diabetes who attended QDA diabetes education or dietetic clinics were included, regardless of fasting intention. Those with pre-diabetes or gestational diabetes were excluded. Assessments began 6-8 weeks before Ramadan, with structured follow-up throughout the month. Primary outcomes-based on patient-recorded blood glucose readings-were defined to capture the overall risk of glycemic instability during Ramadan and included (1) any hypoglycemic (<70 mg/dL) or hyperglycemic (>250 mg/dL) event and (2) any such events during fasting hours. Generalized estimating equation logistic regression models identified factors associated with hypoglycemic or hyperglycemic outcomes. Missing data were <5% and handled by complete-case analysis. Statistical significance was defined as 95% CIs excluding 1. RESULTS: The study included 374 patients; 95.5% of observations were from patients with type 2 diabetes and 43.3% reflected longer diabetes duration. Adjusted ORs indicated higher odds of hypoglycemia or hyperglycemia at any time among patients with a longer diabetes duration, a high International Diabetes Federation-Diabetes and Ramadan risk score, those who discussed a fasting plan with a physician, those who used medications known to increase hypoglycemia risk, and those who used continuous glucose-monitoring devices. During fasting hours, higher odds were observed among patients with type 1 diabetes and those with a higher daily number of recorded blood glucose readings. CONCLUSIONS: The findings underscore the importance of structured pre-Ramadan risk assessment, patient-centered education, close and rigorous follow-up and individualized treatment adjustment-particularly for high-risk groups-to optimize safety and enhance the overall Ramadan experience among persons with diabetes.