A 2025 meta-analysis measured GLP-1 receptor agonist use during Ramadan daytime fasting in 4 studies of 754 people with type 2 diabetes [4]. Compared with other glucose-lowering medicines, the GLP-1 group showed greater hemoglobin reduction, lower documented symptomatic hypoglycemia risk, and more weight loss, but also more nausea and vomiting [4]. The authors describe the evidence as limited and call for larger trials [4]. That Ramadan data cannot answer a Yom Kippur question, because the fasts differ in duration, timing, and metabolic stress. Any plan to fast with a GLP-1 medicine belongs to your clinician and your rav, not to a trial result.
What the Ramadan meta-analysis measured
A 2025 systematic review and meta-analysis examined GLP-1 receptor agonist use by people with type 2 diabetes fasting during Ramadan [4]. The analysis included 4 studies with a combined 754 subjects [4]. Ramadan fasting runs from sunrise to sunset each day for a month, with eating and drinking permitted at night [2]. The measured outcomes during Ramadan daytime fasting were glycated hemoglobin change, documented symptomatic hypoglycemia, weight change, and gastrointestinal side effects [4].
Compared with other glucose-lowering medicines, the GLP-1 receptor agonist group had a mean difference in glycated hemoglobin reduction of 0.31 percentage points during Ramadan fasting [4]. The risk ratio for documented symptomatic hypoglycemia was 0.38 during Ramadan fasting, meaning the GLP-1 group had lower hypoglycemia risk than the comparison group [4]. Weight loss was 2.0 kg greater in the GLP-1 group during Ramadan fasting [4]. Gastrointestinal side effects such as nausea and vomiting were more frequent in the GLP-1 group during Ramadan fasting [4].
The authors of the meta-analysis describe the evidence as limited and call for larger trials [4]. That language matters. A limited evidence base means the findings are preliminary, not final. Larger trials may confirm, refine, or change the picture. The authors are not claiming certainty; they are reporting what 4 studies measured and asking for more research.
Why Ramadan data do not answer the Yom Kippur question
Yom Kippur begins at sundown on September 20, 2026, and ends at nightfall on September 21, 2026 [5]. The fast runs without eating or drinking for the duration. Ramadan fasting is a daily sunrise-to-sunset fast repeated for a month, with eating and drinking permitted at night [2]. The two fasts differ in duration, timing, meal pattern, and total metabolic stress.
A Ramadan trial measures what happens when someone eats at night and fasts during the day, repeated for weeks. A Yom Kippur fast is a single continuous period without food or water. The glucose patterns, medication absorption, and physical stress are not the same. A result from one fasting pattern cannot be transferred to a different fasting pattern without new evidence.
The published literature contains no trial data measuring GLP-1 receptor agonist use during the Yom Kippur fast [4]. No study has enrolled people with diabetes fasting on Yom Kippur and measured their glucose, hypoglycemia risk, or side effects. The absence of that evidence is not a green light; it is an absence. Your plan for fasting with a GLP-1 medicine on Yom Kippur or any other fast belongs to your clinician, who knows your glucose patterns and your medical risk, and to your rav, who knows your observance and your halachic obligation.
What the label says about semaglutide and religious status
The FDA prescribing information for Ozempic, a branded semaglutide injection, writes that semaglutide is a human GLP-1 receptor agonist and that its peptide backbone is produced by yeast fermentation [3]. The label lists the inactive ingredients of the Ozempic pen solution as disodium phosphate dihydrate, propylene glycol, phenol, and water for injections [3]. The prefilled syringe solution contains disodium phosphate dihydrate, sodium chloride, and water for injection [3]. Gelatin, ethanol and alcohol do not appear on either inactive ingredient list [3].
The prescribing information describes ingredients and manufacturing; it does not state any halal, kosher, or religious status [3]. No religious status appears anywhere on the label [3]. That is not a ruling; it is a fact about what the label does and does not say. Questions about the religious status of semaglutide or any GLP-1 medicine belong to your rav. Questions about your exact medicine list and how it interacts with fasting belong to your clinician and pharmacist.
For ingredient details on other GLP-1 medicines, ask your pharmacist to print the prescribing information from the FDA database. The label facts are public and cited. The religious call is your rav's. See the guide to semaglutide and religious status for more on how to bring ingredient questions to your rav.
The IDF-DAR framework for diabetes and fasting
The International Diabetes Federation and the Diabetes and Ramadan International Alliance published formal guidelines in 2021 for diabetes care during Ramadan fasting [2]. The guidelines say that individuals with some illness and serious medical conditions, including some people with diabetes, can be exempted from fasting, yet many will fast anyway [2]. The guidelines emphasize that it is of paramount importance that people with diabetes who fast are given appropriate guidance and receive proper care [2].
That framework applies to Ramadan, but the principle is broader: people with diabetes who fast need guidance and care. Peninei Halakha writes that the preservation of human life overrides the commandments [1]. That principle protects someone whose life may be in danger if they fast. For other fasts, Peninei Halakha writes that sick people who need to take medicine regularly must continue taking their medicine even on a fast day [1]. If possible, swallow it without water; if not, add something bitter to the water until it becomes undrinkable and use it to swallow the pill [1].
The question of whether you are obligated to fast, permitted to fast, or must not fast with your specific medicine and your specific condition is a question for your rav. The question of whether fasting with your medicine is medically safe is a question for your clinician. Neither answer comes from a trial result.
The Ramadan meta-analysis findings at a glance
Here are the outcomes the 2025 meta-analysis measured during Ramadan daytime fasting in people with type 2 diabetes taking GLP-1 receptor agonists.
| Outcome | Ramadan finding | Population |
|---|---|---|
| Glycated hemoglobin reduction | Mean difference 0.31 percentage points greater in GLP-1 group [4] | 754 people with type 2 diabetes fasting during Ramadan [4] |
| Documented symptomatic hypoglycemia | Risk ratio 0.38 in GLP-1 group [4] | 754 people with type 2 diabetes fasting during Ramadan [4] |
| Weight loss | 2.0 kg greater in GLP-1 group [4] | 754 people with type 2 diabetes fasting during Ramadan [4] |
| Gastrointestinal side effects | More frequent nausea and vomiting in GLP-1 group [4] | 754 people with type 2 diabetes fasting during Ramadan [4] |
| Evidence quality | Limited; larger trials needed [4] | 4 studies analyzed [4] |
What to do next
- Ask your clinician whether fasting with your GLP-1 medicine is medically safe for you, given your glucose patterns, your other medicines, and your medical history. Do this before any fast, not during it.
- Ask your clinician what your glucose target is on a fast day and what symptoms of low blood sugar you should watch for.
- Ask your rav whether you are obligated to fast, permitted to fast, or must not fast with your medicine and your condition. Your rav knows your observance and your community's custom.
- If you plan to fast, ask your clinician and pharmacist about your exact medicine list and how each medicine works with fasting. Never skip, delay, split or change any medicine without your clinician's direction.
- Read the guide to fasting with diabetes on Yom Kippur for the halachic framework and the medical questions to bring to your clinician.
- For ingredient details on your GLP-1 medicine, ask your pharmacist to print the FDA prescribing information and review it with your rav if religious status is a question.
- Visit the guides hub to find other fasting and medication resources written for observant readers.
Sources
- Peninei Halakha, the infirm are exempt from fasting, preservation of human life overrides the commandments and medicine on fast days, accessed 2026-08-09, https://ph.yhb.org.il/en/05-07-07/
- IDF-DAR, Diabetes and Ramadan Practical Guidelines 2021, PubMed, diabetes and Ramadan fasting exemptions and guidance, accessed 2026-08-09, https://pubmed.ncbi.nlm.nih.gov/35016991/
- DailyMed, Ozempic (semaglutide) prescribing information, active ingredient, yeast fermentation, inactive ingredients, and absence of religious status, accessed 2026-08-09, https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=adec4fd2-6858-4c99-91d4-531f5f2a2d79
- GLP-1 receptor agonists during Ramadan fasting, 2025 systematic review and meta-analysis, PubMed, glycated hemoglobin, hypoglycemia, weight loss, gastrointestinal side effects, and evidence quality during Ramadan daytime fasting, accessed 2026-08-09, https://pubmed.ncbi.nlm.nih.gov/40900863/
- Hebcal, Yom Kippur 2026, Yom Kippur dates and fast duration, accessed 2026-08-09, https://www.hebcal.com/holidays/yom-kippur-2026