Aims: To compare glycemic variability and continuous glucose monitoring (CGM)-derived metrics before and during Ramadan fasting among adults with type 2 diabetes and cirrhosis. Methods: In this single-center prospective paired-cohort study (Jakarta, January-March 2025), adults with diabetes and cirrhosis wore a real-time CGM system for 14 days pre-and during Ramadan fasting. The primary outcome was coefficient of variation (CV). Secondary outcomes included time in range (TIR), time above range (TAR), time below range (TBR), and ambulatory glucose profiles (AGP). Results: Thirty-two adults completed paired CGM assessments. Median CV was 26.95 % pre-Ramadan and 25.45 % during Ramadan (p = 0.84). TIR showed a modest, non-significant increase (+4.0 pp), TAR a mild rise (+5.2 pp), and TBR remained low (<1% in both periods, p = 0.75). High-risk patients (IDF-DAR risk score > 6) showed greater increases in TAR versus low-moderate risk (p = 0.048). AGP demonstrated reduced daytime variability with distinct post-meal excursions at suhoor and iftar. Conclusions: In adults with diabetes and compensated cirrhosis (Child-Pugh A), Ramadan fasting did not worsen glycemic variability, and hypoglycemia risk remained minimal. Fasting appeared safe in well-selected patients, particularly those classified as low-to-moderate IDF-DAR risk, whereas high-risk or decompensated cirrhosis patients should be counseled against fasting. © 2025