Background: The world is still struggling to control the COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The level of uncertainty regarding the virus is still significantly high. The virus behaves differently in children and young adults. Most children and adolescents are either asymptomatic or have mild symptoms. They generally have a very good prognosis. However, it is not well-known whether children and young adults with type 2 diabetes are at risk of getting a severe infection of COVID-19. Many Muslim children with type 2 diabetes have been performing dawn to dusk fasting during the month of Ramadan, before and during the COVID-19 pandemic, and the impact of this on their health has not been well investigated. Previous studies in adults have suggested that intermittent fasting may be beneficial in different ways including reversal of type 2 diabetes and prevention of COVID-19 infection.Objective: The primary aim of this narrative review is to summarise the impacts of the COVID-19 pandemic on children and young adults with type 2 diabetes, and to identify the knowledge gaps in the literature. It also explores the potential of intermittent fasting in reversing the pathogenesis of diabetes and highlighting how this approach could prevent these patients from developing chronic complications.Methods: This narrative review has been produced by examining several databases, including Google Scholar, Research Gate, PubMed, Cochrane Library, MEDLINE (EBSCO), and Web of Science. The most common search terms used were “COVID-19 AND Children”, “SARS-CoV-2 AND/OR Children”, “COVID-19 AND Diabetes” “COVID-19 Epidemiology”, “COVID-19 AND Ramadan fasting”, “COVID-19 and Intermittent fasting.” All the resources used are either peer-reviewed articles/reports and/or official websites of various media, governmental and educational organisations.Results: Having reviewed the currently limited evidence, it has been found that the incidence of COVID-19 among children with type 2 diabetes seems to be not much different from children without diabetes. However, these patients are still vulnerable to any infection. Several studies have reported that prevention programmes such as intermittent fasting are effective to protect these groups of patients from developing any complications. Moreover, observing Ramadan fasting as a type of intermittent fasting could be beneficial for some children with established diabetes, prediabetes and people at risk.Conclusion: Children and young adults with type 2 diabetes are not at risk of severe COVID-19 infection as the case in adults with diabetes. More research is needed to identify the impact of COVID-19 and to investigate the efficacy and safety of intermittent fasting, including Ramadan fasting, among these age groups. Implementing these cost-effective programmes may have a great impact in minimising the incidence of diabetes. Moreover, this could be effective particularly at prediabetes stage by preventing these people from going onto develop type 2 diabetes and taking medications for the rest of their life and protecting people from complications linked to disease and infection.

Background: Ramadan is a sacred month in Islam, which involves 29–30 days of dawn-till-dusk dry-fasting. Millions of Muslims observed Ramadan fasting (RF) this year in the midst of the COVID-19 pandemic. Certain ethnic groups worldwide, including Muslims, have been disproportionately affected by COVID-19, raising fears that fasting could bring additional health risks. This directly impacted on the current challenges faced by health professionals. The COVID-19 virus is expected to become seasonal. Therefore, the evidence presented in this review is valid beyond Ramadan as intermittent fasting is practiced more widely, irrespective of religion, throughout the year as a therapeutic and prophylactic means for several conditions.  Methods: A wide range of literature databases were searched for the effects of RF and intermittent fasting on human health and then linked to COVID-19 impact to generate the evidence. Results: This review presents a body of evidence proving RF is safe and beneficial for healthy people who adopt a balanced diet, drink plenty of fluids, and engage in regular physical activity. Fasting reduces levels of pro-inflammatory cytokines (IL-1β and IL-6), which are associated with severe COVID-19.  Furthermore, increased handwashing and hygiene during Ramadan may reduce infection risks. For some, social isolation, physical inactivity, reduced access to food and stress – linked to the pandemic – may minimize the benefits that is achieved during a “normal” Ramadan. Conclusions: RF during the COVID-19 pandemic is not a cause of concern for healthy people. However, people who are ill are exempt from fasting and should seek medical advice if they wish to fast. RF during the COVID-19 pandemic is a unique experience and future research will reveal its impact on human health. Key words: COVID-19; Ramadan; fasting; health; mental; exercise; isolation; lockdown; diabetes; biomarkers

Introduction:The prevalence of type 2 diabetes (T2D) is increasing around the world. Although Muslims with a physical illness are exempted from fasting during the month of Ramadan, a great number still choose to fast, often without medical consultations. The aim of this systematic review and meta-analysis was to investigate the impact of observing Ramadan fasting (RF) on glycaemic control in patients with T2D.Methods: The Web of Science, Scopus, EBSCOhost, CINAHL, ScienceDirect, Cochrane Library, ProQuest Central and Europe PubMed Central (Medline) databases were searched for relevant studies published between January 2000 and December 2021. Observational studies that examined the changes in body weight (BW) and glucose parameters (glycosylated haemoglobin [HbA1c] and fasting blood glucose [FBG]), before and after RF among different age groups with T2D were included in the systemic review and meta-analysis. Effect sizes for the tested outcomes were calculated as weighted mean difference (WMD), with their confidence intervals (CI). Quality assessment was examined using the National Heart, Lung, and Blood Institute (NHLBI) tool.