Knowledge, attitudes, and practices of community pharmacists regarding the management of diabetes during Ramadan in the Aseer Region, Saudi Arabia

Background Fasting during Ramadan causes challenges for diabetes treatment, necessitating tailored counseling and adjustments for medication. Community pharmacists play a vital role in enhancing fasting safety, although their readiness has not been well investigated in southern Saudi Arabia. This study aimed to evaluate community pharmacists’ knowledge, attitudes, and practices (KAP) regarding diabetes management during Ramadan in the Aseer Region, and to identify perceived barriers and the need for additional training. Methods A descriptive cross-sectional study was performed from February to May 2025 with 301 licensed community pharmacists in the Aseer Region. Participants were recruited through professional pharmacy social media platforms and pharmacy communication groups commonly used within the region. Data were collected utilizing a previously validated self-administered questionnaire. Descriptive and inferential statistics were conducted using SPSS v26, with a significance level set at p < 0.05. Inferential findings were interpreted cautiously as subgroup comparisons. Results A total of 301 pharmacists participated. Knowledge of key safety measures during fasting was high, with 91.7% correctly identifying the blood glucose threshold (<60 mg/dL) requiring termination of fasting. Correct recognition of high-risk patients who should avoid fasting was reported for patients with recurrent hypoglycemia (88.7%) and elderly or unwell patients (87.4%). Knowledge related to medication regimen adjustment was lower, particularly in insulin dose modification, where 71.1% provided correct responses. In practice, more than 80% counseled patients on blood glucose monitoring and meal planning, while 63.8% addressed physical activity adjustments, and 68.1% counseled on medication regimen changes. The most frequently reported barriers were time constraints (85.7%), lack of updated training (84.7%), and inadequate counseling privacy (79.8%). Prior training was associated with higher knowledge and practice scores (p = 0.001). Pharmacists who attended training workshops demonstrated higher mean knowledge and practice scores than untrained pharmacists. Conclusion Community pharmacists in the Aseer Region demonstrated generally adequate knowledge and positive attitudes regarding diabetes management during Ramadan, particularly in fasting-safety counseling and patient education. However, important gaps remained in advanced medication regimen adjustment practices, especially insulin dose modification, as well as participation in structured public education activities. Continuing professional development programs focused on Ramadan-specific diabetes management and interprofessional collaboration may improve pharmacist-led diabetes care during Ramadan.