Optimization of Basal Insulin During Ramadan Fasting in Type 2 Diabetic Patients: Comparison Between DAR Recommendations and the Carbohydrate Fasting Test & Metabolic and Inflammatory Consequences

Inclusion Criteria

• •Adults aged 18 to 70 years with Type 2 diabetes on a basal insulin regimen (NPH, Detemir, or Glargine) with or without 1 to 2 boluses of rapid-acting insulin.
• •Diabetes duration of at least 2 years and insulin therapy for at least 6 months.
• •Patients wishing to fast during Ramadan and having provided informed consent.
• •Low risk of complications according to the IDF-DAR 2021 risk score or moderate risk for patients who insist on fasting.
• •High-risk patients according to IDF-DAR 2021 score \>6, including those with:
• •Severe renal impairment
• •Cognitive dysfunction or frailty
• •Unrecognized hypoglycemia
• •Unstable cardiovascular disease
• •Pregnancy
• •Type 1 diabetes
• •Type 2 diabetes patients on sulfonylureas or related medications