Diabetic control may represent a difficulty during Ramadan fast in diabetic patients. We analyzed the effect of Ramadan fast in diabetic kidney transplant recipients to sort out difficulties and limitations and give the proper advice to them. Patients and methods: We prospectively studied 39 diabetic kidney transplant recipients during the month of Ramadan. Out of this group 18 patients were fasting and 21 were not fasting and taken as a control group. 7 patients in the fasting group were insulin dependent and 11 patients were on hypoglycemic drugs. Stable renal function for the previous 6 months with serum creatinine less 200 umol/l, adequate diabetic control and drug dosage as twice per day or less were the main inclusion criteria. The follow up parameters before, during and after Ramadan were renal function, blood sugar and blood pressure control. Adverse events and patient satisfaction were recorded. There was no statistically significant difference in renal function, blood pressure or blood sugar control between the fasting and non fasting groups. All patients tolerated the fasting well without any adverse effects. However, there was a tendency for higher blood sugar levels in the fasting group specially in those patients who were insulin dependent compared to the non fasting group. This difference was still statistically non-significant. Diabetic kidney transplant recipients with normal renal function can fast during Ramadan. Patient education regarding diet and diabetes should improve the glycemic control in these patients.