This study aims to examine the effects of fasting during Ramadan on treatment adherence, psychological adjustment, and glycemic control in individuals with type 2 diabetes. While Ramadan fasting is a religious practice, it can also pose health risks such as hypoglycemia, hyperglycemia, and metabolic imbalance in individuals with diabetes. Adherence to treatment and self-care, as well as psychosocial adjustment, are crucial in the effective management of diabetes. Given that a large portion of Turkey's population is Muslim, comparing individuals with type 2 diabetes who fast and those who do not during Ramadan will contribute to improving patient care within a cultural and religious context. The findings of this study are expected to guide nurses in developing personalized, culturally sensitive care plans tailored to the needs of individuals before, during, and after Ramadan.

Fasting during Ramadan is a religious practice observed globally by adult Muslims. Individuals fast during Ramadan due to an emotional and spiritual connection to the holy month. Fasting involves abstaining from food, drink, and oral medications for a month, between sunrise and sunset each year. The duration of Ramadan fasting varies between 10 and 19 hours depending on geographical and seasonal conditions. While this is a religious practice, those who fast may experience various health risks, particularly for individuals with type 1 and type 2 diabetes.

Diabetes mellitus is an insidious chronic metabolic disease characterized by high blood sugar levels that cause serious damage to all body systems over time. Diabetes is a chronic disease that has increased in recent years and leads to morbidity, loss of productivity, decreased quality of life, and mortality in individuals due to various complications. Adherence to treatment plays a critical role in the treatment, care, and management of chronic diseases.

According to the WHO, adherence to treatment in diabetic patients is defined as a self-care process that includes home blood sugar monitoring, regulation of food consumption, medication use, regular physical activity, foot care, regular visits to the doctor for periodic check-ups, and dental care. Individuals who adhere to treatment in chronic diseases can exhibit effective coping skills, avoid psychological problems, experience fewer negative emotions, implement healthy lifestyle changes, and maintain control over their health status.

The psychological aspect of chronic diseases is often underestimated. Although it is assumed that most patients adapt well to the psychological aspects of chronic diseases, it becomes more difficult to adapt psychologically when patients experience deficiencies in their physical health status. Diabetes is a chronic disease that leads to mental and cognitive problems in addition to physiological complications, and it takes time to cope with it. Therefore, understanding the psychosocial adaptation to the disease in individuals with diabetes will guide nurses in positively influencing disease management and preventing or delaying possible complications. In addition, fasting negatively affects individuals with diabetes physically, socially, and psychologically. Glycemic control before Ramadan is considered a key determinant of fasting safety in individuals with diabetes.

In light of this information, and given that the Turkish population is predominantly Muslim, this study aims to examine the effects of fasting and non-fasting during Ramadan on treatment adherence, psychological adjustment, and glycemic control in individuals with Type 2 diabetes. The results of this study are expected to guide healthcare professionals, particularly nurses who have the most contact with patients, in understanding cultural and religious practices before, during, and after Ramadan to provide personalized care tailored to patients' needs. Through this study, we aimed to identify effective strategies to improve both treatment adherence and psychological adjustment by positively impacting the treatment, care, and management of diabetic patients

Inclusion Criteria:

Individuals ≥18 years of age

Able to give informed consent

Diagnosed with type 2 diabetes

Planning to fast during Ramadan

Exclusion Criteria:

Presence of psychiatric illness

Presence of cognitive impairment

Receiving additional treatments that significantly affect glucose levels (e.g., ongoing steroid therapy)

Individuals who have decided not to fast during Ramadan

Individuals who have stopped fasting during Ramadan

Individual patient data will not be shared due to the need to protect participant confidentiality, the privacy of personal health information, and compliance with applicable ethical committee approval and data protection legislation (KVKK). Data will only be analyzed for scientific purposes in an anonymized and aggregated form, and there are no plans to share raw data containing individually identifying information with third parties. This approach has been adopted to protect participant rights and ensure compliance with ethical research principles.

Patients were randomly assigned to groups, and interviews were scheduled at different times to minimize the possibility of interaction between them. Additionally, patients were informed about the study and their consent was obtained prior to the study.