Risk Stratification in People with Diabetes for Fasting During Ramadan: Consensus from Arabic Association for the Study of Diabetes and Metabolism

Abstract

Background: Current international guidelines recommend a pre-Ramadan risk assessment for people with diabetes (PwDM) who plan on fasting during the Holy month. However, a comprehensive risk assessment-based recommendation for the management of PwDM intending to fast is still controversial. Therefore, the Arabic Association for the Study of Diabetes and Metabolism (AASD) developed this consensus to provide further insights into risk stratification in PwDM intending to fast during Ramadan. Methods: The present consensus was based on the three-step modified Delphi method. The modified Delphi method is based on a series of voting rounds and in-between meetings of the expert panel to reach agreements on the statements that did not reach the consensus level during voting. The panel group comprised professors and consultants in endocrinology (both adult and pediatric). Other members included experts in the fields of cardiovascular medicine, nephrology, ophthalmology, and vascular surgery, affiliated with academic institutions in Egypt. Result: In PwDM who intend to fast during Ramadan, risk stratification is crucial to optimize patient outcomes and prevent serious complications. The present consensus provides risk assessment of those living with diabetes according to several factors, including the type of diabetes, presence, and severity of complications, number of fasting hours, and other socioeconomic factors. According to their risk factors, patients were classified into four categories (very high, high, moderate, and low risk). Conclusion: Future research is warranted due to the controversial literature regarding the impact of fasting on certain comorbidities.

Diabetes and Ramadan Fasting (2023): The Year in Review

“…Several studies in 2023 evaluated the potential challenges and values of using the 2021 IDF-DAR (International Diabetes Federation-Diabetes and Ramadan Alliance) risk stratification tool (►Table 2). [14][15][16][17][18] The original creators of the tool investigated its validity using two different approaches. In the first study, they performed a prospective, survey-based study before and after Ramadan (2021) to explore the ability of the new IDF-DAR risk stratification tool to predict the probability of fasting and complications risk.…”

“…Furthermore, another diabetes group based in Egypt released a consensus statement to provide further insights into risk stratification in PWD intending to fast during Ramadan based on the three-step modified Delphi method. 18 The panel comprised senior adult and pediatric endocrinologists and other experts in relevant specialties affiliated with academic institutions in Egypt. The group developed a new risk assessment tool based on several factors, including the type, presence, and severity of complications, the number of fasting hours, and certain socioeconomic factors.…”