Background: Chronic diseases almost always result in physical, psychological, financial, and social burdens on the patients and the economy. Studies examining the effects of fasting on diabetes during Ramadan emphasized the biochemical changes without considering the psychosocial and financial implications. This study aimed to illuminate some of the challenges faced by both fasting and non-fasting diabetic patients during Ramadan. Methods: This was a community-based cross-sectional study conducted from August 2015 to October 2015. Diabetes 39 instrument was administered to 112 patients with diabetes in Khartoum to evaluate their health-related quality of life during Ramadan. Results: Fifty-four percent of study participants were female and 64.3% were between 40-60 years old. Sixty-two participants were able to fast (55.4%) and more than 80% of these fasted for > 15 days. Half of the participants had, at least, one comorbidity with hypertension being the most common. Approximately 59% of fasting patients had mild impairment in their health-related quality of life, whereas 60% of non-fasting participants had moderate impairment. Limited energy levels, the need to rest often, and fear of hypoglycemia were the items with the highest mean scores in both groups. The fasting group had a lower average score (2.88) when compared to the non-fasting group (3.66). This difference was statistically significant (p=0.033). Conclusion: Over 53% of study patients fasted for at least for 1 day during Ramadan. Interestingly, Patients who fasted had a better health-related quality of life when compared to those who did not fast.