Article Summary Recommendations for management of diabetes during Ramadan. Al-Arouj M, Bouguerra R, Buse J, Hafez S, Hassanein M, Ibrahim MA, Ismail-Beigi F, El-Kebbi I, Khatib O, Kishawi S, Al-Madani A, Mishal AA, Al-Maskari M, Nakhi AB, Al-Rubean K. Diabetes Care. 2005;28:2305-2311. Objective: To put forth suggestions for the treatment of Muslim patients with diabetes who choose to fast during Ramadan. These recommendations are made for the following reasons: (1) to promote open dialogue about this topic; (2) to document the medical opinions and suggestions of members of the American Diabetes Association (ADA) Workgroup; and (3) to reveal related topics about which not enough is known, with the goal of guiding future research. Observations: Fasting, especially when it is undertaken by patients with diabetes, is associated with numerous health risks. Major complications have been noted to occur in those with diabetes who fast and include hypoglycemia, hyperglycemia, diabetic ketoacidosis, and dehydration and thrombosis. Most often, the professional recommendation for patients with diabetes is to refrain from fasting. Data from the 2004 population-based Epidemiology of Diabetes and Ramadan (EPIDIAR) study show that among 12,243 people with diabetes from 13 Islamic countries, approximately 43% of those with type 1 diabetes and about 79% of patients with type 2 diabetes fast during Ramadan–a total of 40 to 50 million people worldwide. For persons with diabetes, the decision to fast during Ramadan should be made only after physical examination, discussion with their healthcare provider, and participation in appropriate educational initiatives designed to guide patients in decision making regarding physical activity, meal planning, glucose monitoring, and dosage and timing of medications. It is essential that the Muslim patient with diabetes make the decision of whether to fast during Ramadan only after carefully considering the risks and possible consequences. Conclusions: Given the known risks of fasting associated with both type 1 and type 2 diabetes, patients who practice Islam should make the personal decision of whether to fast during Ramadan only after they have undergone physical assessment and discussed with their heathcare provider the risks involved. Management for this situation must be highly individualized according to patient risk factors and needs. Close clinical follow-up ensures that the risk of complications is reduced. Future research should seek to further the clinician’s understanding of the risks and risk factors that determine outcomes when patients with diabetes fast. Clear data from such studies will serve to clarify risk categories and will assist in the refinement of management guidelines.