Background: First, estimate the rate of diabetic patients who fast during Ramadan in Tunisia and associated factors. Next, assess, medical history and treatment of fasting diabetic patients. Finally, we reported the attitude of physicians in term of treatment adaptation for fasting diabetic patients. Methods: This was an observational, cross-sectional study conducted in Tunisia. A single visit was made during the month following Ramadan. 1266 diabetes patients were included. Results: Investigators recruited 89 (7%) patients with type 1 diabetes and 1177 (93%) patients with type 2 diabetes. During Ramadan 39% of patients with type 1 diabetes and 66,3% with type 2 diabetes fasted. Fasting was significantly less frequent among women and patients who have not attended school. Patients with T1 diabetes duration greater or equal to 10 years, insulin using and hypoglycemia before Ramadan fasted significantly less frequently. The existence of co morbidity reduced significantly fasting practice during Ramadan, while self-glycemic monitoring increased fasting practice. The vast majority of patients (76.1%) decided to fast on their own. Normal values of Hb1Ac before Ramadan increased significantly fasting practice (p = 0.0003). A comparison between the two periods before and during Ramadan revealed that no significant variation in the mean number of severe episodes of hypoglycemia was observed. Conclusions:\r\nThe main challenge for physicians, during Ramadan, remains the large proportion of diabetic patients who fast. To minimize the risk associated with fasting there is an urgent need to educate diabetes patients, to consider the socio-cultural representations and not only biomedical aspects

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