Each year, millions of Muslims across the globe fast during the month of Ramadan, a practice that can pose significant health risks for individuals with diabetes. While fasting is a personal decision and one that should be made with the guidance of healthcare providers, recent advancements have helped develop tools to predict the safety of fasting in diabetic patients. A landmark study published in the Saudi Medical Journal on January 26, 2024, titled “Validity of the International Diabetes Federation risk stratification score of Ramadan fasting in individuals with diabetes mellitus,” sheds light on a new risk stratification tool’s efficacy for hypertension and diabetes patients fasting during Ramadan.
The International Diabetes Federation-Diabetes and Ramadan International Alliance (IDF-DAR) has introduced a risk stratification score intended to help people with diabetes and their healthcare providers make informed decisions about fasting. This prospective observational study, conducted during Ramadan 2022 at the Diabetes Center, King Fahad Hospital, Al-Madinah Al-Munawarah, Saudi Arabia, compassionately scrutinized the accuracy and reliability of the aforementioned tool in classifying patients according to their risk levels.
Background: The Practice of Ramadan Fasting and Diabetes
Ramadan, the ninth month of the Islamic lunar calendar, is marked by Muslims as a period of fasting from dawn until sunset. During fasting hours, adherents refrain from eating, drinking, smoking, and taking oral medications. For patients with diabetes, especially those relying on insulin therapy or oral hypoglycemic agents, the long hours without food and medicine increase the risk for acute metabolic complications such as hypoglycemia, hyperglycemia, and diabetic ketoacidosis. Proper risk assessment is thus vital to avoid health-related adverse events.
Materials and Methods: The IDF-DAR Risk Stratification Study
Under the leadership of Eman M. Alfadhli and her colleagues, the study aimed to assess the IDF-DAR risk stratification tool’s validity. The patient cohort consisted of 466 individuals with diabetes, 79.4% with type 2 diabetes mellitus (T2DM) and 20.6% with type 1 diabetes mellitus (T1DM). Prior to Ramadan, patients were categorized as high, moderate, or low risk using the IDF-DAR score. Throughout the fasting period, participants maintained a daily log of fasting activities. A follow-up interview was conducted post-Ramadan to evaluate their experiences.
Results: The Effectiveness of the IDF-DAR Tool
The results were revealing. Out of the study group, 265 patients (56.9%) were categorized as high risk, 115 (24.7%) as moderate risk, and 86 (18.4%) as low risk. The outcomes correlated statistically with the risk stratification; high-risk patients exhibited more instances of hypoglycemia and hyperglycemia compared to their moderate- and low-risk counterparts. Nonetheless, the majority of moderate-risk individuals (70.4%) and over half of the high-risk patients (53.2%) completed the entire month of fasting without significant incidents. This indicates that while the IDF-DAR tool is consistent in predicting risk, it may overestimate the fasting risk for some.
Discussion: Implications and Recommendations
The study concluded that the IDF-DAR risk stratification score is a reliable tool for evaluating the safety of Ramadan fasting in diabetic patients. It aids in making important clinical decisions. However, as the tool might overestimate risks, individual patient assessment remains crucial. The research echoes the principles outlined in the updated recommendations for managing diabetes during Ramadan (Ibrahim et al., 2020), emphasizing personalized care and monitoring of glucose levels.
Future Research
The study paves the way for more extensive research into tailoring fasting recommendations based on individual risk levels. Future investigations could, for instance, focus on real-time glucose monitoring to allow for dynamic adjustments to fasting plans.
Limitations
Though valuable, the study did have its limitations. The observational nature of the research means causality cannot be established, and the sample size may not fully represent the global diversity of Muslim diabetics. Further multicenter studies would help validate the findings across various populations.
Conclusion
The IDF-DAR risk stratification tool has been validated as an efficient method for predicting the safety of fasting among diabetic patients. Healthcare providers should integrate this tool within the myriad of factors they consider, offering a balanced and well-informed approach to Ramadan fasting.
References
1. Alfadhli Eman M, et al. “Validity of the International Diabetes Federation risk stratification score of Ramadan fasting in individuals with diabetes mellitus.” Saudi Medical Journal, vol. 45, no. 1, 2024, pp. 86-92. DOI:10.15537/smj.2024.45.1.2023060.
2. Hassanein M, et al. “Diabetes and Ramadan: practical guidelines 2021.” Diabetes Research and Clinical Practice, vol. 185, 2022. DOI:10.1016/j.diabres.2021.109185.
3. Kamrul-Hasan ABM, et al. “Risk stratification using the 2021 IDF-DAR risk calculator and fasting experience of Bangladeshi subjects with type 2 diabetes in Ramadan: The DAR-BAN study.” Journal of Clinical Translational Endocrinology, vol. 31, 2023. DOI:10.1016/j.jcte.2023.100315.
4. Ibrahim M, et al. “Recommendations for management of diabetes during Ramadan: update 2020, applying the principles of the ADA/EASD consensus.” BMJ Open Diabetes Research & Care, vol. 8, 2020, e001248. DOI:10.1136/bmjdrc-2020-001248.
5. Loh HH, et al. “Safety of Ramadan fasting in young patients with type 1 diabetes: a systematic review and meta-analysis.” Journal of Diabetes Investigation, vol. 10, no. 6, 2019, pp. 1490-1501. DOI:10.1111/jdi.13090.
Keywords
1. Ramadan fasting diabetes
2. IDF-DAR risk score
3. Diabetes management during Ramadan
4. Hypoglycemia in fasting diabetics
5. Fasting risk prediction tool