OBJECTIVE: This systematic review and meta-analysis assess the effects of Ramadan fasting in adolescents with type 1 diabetes mellitus (T1DM), on blood sugar factors such as hemoglobin A1C and problems caused by its lack of control such as hypoglycemia and DKA, and metabolic outcomes. METHODS: Electronic databases including MEDLINE, Embase, and SINOMED were searched up to February 13, 2024, without language, region, or publication time restrictions. The outcomes were Acute complications, changes in Hemoglobin A1c (HbA1c) and weight changes. Meta-analyses used random-effects models to compute weighted Relative risk (RR) and standard mean differences (SMD). And to check the risk of bias of included studies, the Newcastle-Ottawa scale was used. RESULTS: Nine studies were included, comprising 458 participants, with studies varying in quality from high to low. Meta-analysis showed no significant reduction in HbA1c levels post-Ramadan (SMD: -0.12
95% CI: -0.38 to 0.14), indicating minimal impact on long-term glycemic control. The incidence of hypoglycemia was notably high (50.79 events per 100 observations), with hyperglycemia and diabetic ketoacidosis (DKA) also reported but less frequently. The variability in complication rates among studies was significant, reflecting the high heterogeneity across the data. Weight changes during Ramadan were minimal and not statistically significant, suggesting fasting's negligible effect on body weight among participants. CONCLUSIONS: Ramadan fasting among adolescents with T1DM does not significantly alter HbA1c levels, suggesting potential feasibility under careful monitoring and management. However, the high incidence of hypoglycemia underscores the need for vigilant glucose monitoring and tailored adjustments to diabetes management plans during fasting periods.