Concern for Muslims with diabetes fasting during Ramadan has been recognised by religious leaders and indeed 2009 saw a landmark event. A statement was issued at the meeting of the Council of the International Islamic Fiqh Academy of the Organisation of Islamic Conference at its 19th session. In brief, people with diabetes were classified into four categories in line with expert recommendations published in 2005. Categories 1 and 2 include those with diabetes at very high risk of serious complications and high risk of complications due to fasting, respectively. These two groups are exempt from observing Ramadan. Categories 3 and 4 include those with diabetes who have a medium risk of complications and those with a low risk of complications due to fasting, respectively. The latter two groups are not automatically exempt from observing Ramadan. The risk of complications in this context refers specifically to the likelihood of hypoglycaemic events, and includes other acute illnesses associated with diabetes, patients on renal dialysis, women with diabetes during pregnancy, patients with macrovascular disease, and those who live alone and are on insulin therapy or oral insulin secretagogues. Additionally, all people with T1DM are classed as category 1. However, the impact of the feasting part of Ramadan, for example on hyperglycaemia or deterioration of glycaemic control, is not considered in this statement. Furthermore, it is not known to what extent these guidelines are followed in practice.