Review Article

Diabetes Management Challenges During Intermittent Fasting Among Adolescents: A Narrative Review of Recent Evidence

Abstract

Intermittent fasting is increasingly practiced by adolescents for religious, cultural, and lifestyle reasons, yet its implications for diabetes management during this critical developmental period remain insufficiently defined. Adolescents with diabetes represent a uniquely vulnerable population due to pubertal insulin resistance, dynamic hormonal changes, evolving self-management capacity, and heightened psychosocial influences. This narrative review synthesizes evidence from the past 10–15 years on the glycemic, metabolic, treatment-related, psychosocial, and health system challenges associated with intermittent fasting among adolescents with diabetes. Available evidence indicates that fasting may increase the risk of hypoglycemia, hyperglycemia, ketosis, dehydration, and psychological distress, with risk profiles varying by diabetes type, fasting pattern, treatment regimen, and sociocultural context. Insulin-treated adolescents, particularly those with type 1 diabetes, are at heightened risk of acute metabolic decompensation, while those with type 2 diabetes face challenges related to medication tolerability, hydration, and adherence. Psychosocial factors, including peer influence, social media–driven fasting behaviors, family expectations, and faith-based obligations, play a central role in shaping fasting decisions and safety. Structural inequities, including limited access to diabetes technologies and inconsistent clinical guidance, further exacerbate risk, especially in low- and middle-income settings. This review highlights the need for individualized, context-sensitive management strategies grounded in pre-fasting risk assessment, shared decision-making, tailored treatment and monitoring adaptations, and adolescent-centered education. Future research priorities include adolescent-specific clinical trials, longitudinal evaluation of developmental outcomes, integration of behavioral science with endocrinology, and the development of ethical, evidence-based guidelines to support safe fasting practices in this population.