Cortisol-glucose coupling dynamics in Ramadan-fasting T2D patients: a multimodal sensing framework for HPA-axis-adjusted glycemic variability prediction

Fahad Yahya Ahmed Mushari; Joud Nasser Aldossary; Faisal Sultan Hadish Asiri; Marya Abdulhamid Almaa; Qusay Mohammed Aldandan; Tuqa Ahmed Alabdalal; Roaa Omar Alattas; Yazeed Ahmed Alluqmani; Abdullah Saleem Alsaadi; Saja Samir Alerwi; Waad Abdullah Alrashdi; Mostafa Habeeb Alhodibi

doi:10.24911/IJMDC.51-1765721224

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Original Article
Online Published: 19 Jan 2026

IJMDC. 2026; 10(1): 180-188

doi: 10.24911/IJMDC.51-1765721224

Cortisol-glucose coupling dynamics in Ramadan-fasting T2D patients: a multimodal sensing framework for HPA-axis-adjusted glycemic variability prediction

Fahad Yahya Ahmed Mushari, Joud Nasser Aldossary, Faisal Sultan Hadish Asiri, Marya Abdulhamid Almaa, Qusay Mohammed Aldandan, Tuqa Ahmed Alabdalal, Roaa Omar Alattas, Yazeed Ahmed Alluqmani, Abdullah Saleem Alsaadi, Saja Samir Alerwi, Waad Abdullah Alrashdi, Mostafa Habeeb Alhodibi.

Abstract
Objective: This study aimed to evolve a multimodal physiological framework to be able to measure the dynamic association of cortisol rhythms and glycemic fluctuation in Ramadan fasting.
Methods: Thirty-four adults were assessed at pre-Ramadan, Ramadan, and post-Ramadan. High-frequency salivary cortisol sampling was combined with continuous glucose monitoring (CGM). To measure delays in cortisol action, a time-dependent coupling function was constructed to separate hypothalamic-pituitary-adrenal (HPA) axis-driven glucose excursions from dietary or behavioral effects. Glycemic variability indexes were adjusted with cortisol to complement the CGM measures. The GRU prediction model with cortisol peaks and heart-rate variability was evaluated to predict glucose in the short term.
Results: There was a clear bimodal pattern of cortisol response in fasting with peaks before suhur and after iftar, which were glucose nadirs and postprandial spikes. The cortisol-adjusted variability indices showed stronger associations with hypoglycemia risk and post-iftar hyperglycemia than conventional CGM variables. The integrated GRU model was more accurate and sensitive at predicting hypoglycemia than glucose-only models.
Conclusion: The dynamics of the HPA-axis played an essential role in glycemic fluctuations during Ramadan fasting. The given framework can offer a more physiologically based approach to interpreting glucose variations and can be used to provide safer, personalized fasting guidance to patients with type 2 diabetes (T2D).

Key words: Type 2 diabetes, Ramadan fasting, cortisol rhythms, glycemic variability, HPA axis, continuous glucose monitoring, glucose forecasting.

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Pubmed Style

Mushari FYA, Aldossary JN, Asiri FSH, Almaa MA, Aldandan QM, Alabdalal TA, Alattas RO, Alluqmani YA, Alsaadi AS, Alerwi SS, Alrashdi WA, Alhodibi MH. Cortisol-glucose coupling dynamics in Ramadan-fasting T2D patients: a multimodal sensing framework for HPA-axis-adjusted glycemic variability prediction. IJMDC. 2026; 10(1): 180-188. doi:10.24911/IJMDC.51-1765721224

Web Style

Mushari FYA, Aldossary JN, Asiri FSH, Almaa MA, Aldandan QM, Alabdalal TA, Alattas RO, Alluqmani YA, Alsaadi AS, Alerwi SS, Alrashdi WA, Alhodibi MH. Cortisol-glucose coupling dynamics in Ramadan-fasting T2D patients: a multimodal sensing framework for HPA-axis-adjusted glycemic variability prediction. https://www.ijmdc.com/?mno=303188 [Access: January 25, 2026]. doi:10.24911/IJMDC.51-1765721224

AMA (American Medical Association) Style

Mushari FYA, Aldossary JN, Asiri FSH, Almaa MA, Aldandan QM, Alabdalal TA, Alattas RO, Alluqmani YA, Alsaadi AS, Alerwi SS, Alrashdi WA, Alhodibi MH. Cortisol-glucose coupling dynamics in Ramadan-fasting T2D patients: a multimodal sensing framework for HPA-axis-adjusted glycemic variability prediction. IJMDC. 2026; 10(1): 180-188. doi:10.24911/IJMDC.51-1765721224

Vancouver/ICMJE Style

Mushari FYA, Aldossary JN, Asiri FSH, Almaa MA, Aldandan QM, Alabdalal TA, Alattas RO, Alluqmani YA, Alsaadi AS, Alerwi SS, Alrashdi WA, Alhodibi MH. Cortisol-glucose coupling dynamics in Ramadan-fasting T2D patients: a multimodal sensing framework for HPA-axis-adjusted glycemic variability prediction. IJMDC. (2026), [cited January 25, 2026]; 10(1): 180-188. doi:10.24911/IJMDC.51-1765721224

Harvard Style

Mushari, F. Y. A., Aldossary, . J. N., Asiri, . F. S. H., Almaa, . M. A., Aldandan, . Q. M., Alabdalal, . T. A., Alattas, . R. O., Alluqmani, . Y. A., Alsaadi, . A. S., Alerwi, . S. S., Alrashdi, . W. A. & Alhodibi, . M. H. (2026) Cortisol-glucose coupling dynamics in Ramadan-fasting T2D patients: a multimodal sensing framework for HPA-axis-adjusted glycemic variability prediction. IJMDC, 10 (1), 180-188. doi:10.24911/IJMDC.51-1765721224

Turabian Style

Mushari, Fahad Yahya Ahmed, Joud Nasser Aldossary, Faisal Sultan Hadish Asiri, Marya Abdulhamid Almaa, Qusay Mohammed Aldandan, Tuqa Ahmed Alabdalal, Roaa Omar Alattas, Yazeed Ahmed Alluqmani, Abdullah Saleem Alsaadi, Saja Samir Alerwi, Waad Abdullah Alrashdi, and Mostafa Habeeb Alhodibi. 2026. Cortisol-glucose coupling dynamics in Ramadan-fasting T2D patients: a multimodal sensing framework for HPA-axis-adjusted glycemic variability prediction. International Journal of Medicine in Developing Countries, 10 (1), 180-188. doi:10.24911/IJMDC.51-1765721224

Chicago Style

Mushari, Fahad Yahya Ahmed, Joud Nasser Aldossary, Faisal Sultan Hadish Asiri, Marya Abdulhamid Almaa, Qusay Mohammed Aldandan, Tuqa Ahmed Alabdalal, Roaa Omar Alattas, Yazeed Ahmed Alluqmani, Abdullah Saleem Alsaadi, Saja Samir Alerwi, Waad Abdullah Alrashdi, and Mostafa Habeeb Alhodibi. "Cortisol-glucose coupling dynamics in Ramadan-fasting T2D patients: a multimodal sensing framework for HPA-axis-adjusted glycemic variability prediction." International Journal of Medicine in Developing Countries 10 (2026), 180-188. doi:10.24911/IJMDC.51-1765721224

MLA (The Modern Language Association) Style

Mushari, Fahad Yahya Ahmed, Joud Nasser Aldossary, Faisal Sultan Hadish Asiri, Marya Abdulhamid Almaa, Qusay Mohammed Aldandan, Tuqa Ahmed Alabdalal, Roaa Omar Alattas, Yazeed Ahmed Alluqmani, Abdullah Saleem Alsaadi, Saja Samir Alerwi, Waad Abdullah Alrashdi, and Mostafa Habeeb Alhodibi. "Cortisol-glucose coupling dynamics in Ramadan-fasting T2D patients: a multimodal sensing framework for HPA-axis-adjusted glycemic variability prediction." International Journal of Medicine in Developing Countries 10.1 (2026), 180-188. Print. doi:10.24911/IJMDC.51-1765721224

APA (American Psychological Association) Style

Mushari, F. Y. A., Aldossary, . J. N., Asiri, . F. S. H., Almaa, . M. A., Aldandan, . Q. M., Alabdalal, . T. A., Alattas, . R. O., Alluqmani, . Y. A., Alsaadi, . A. S., Alerwi, . S. S., Alrashdi, . W. A. & Alhodibi, . M. H. (2026) Cortisol-glucose coupling dynamics in Ramadan-fasting T2D patients: a multimodal sensing framework for HPA-axis-adjusted glycemic variability prediction. International Journal of Medicine in Developing Countries, 10 (1), 180-188. doi:10.24911/IJMDC.51-1765721224

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