Risk Stratification for Fasting in Diabetic Patients Based on the IDF-DAR Guideline

Document Type : Research Paper

Authors

1 Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Clinical Research Development Unit, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction: Fasting during Ramadan is a religious obligation and may pose a risk to diabetic patients. This study aimed to stratify diabetic patients based on the International Diabetes Federation- Diabetes and Ramadan International Alliance (IDF- DAR) guideline for the risk of fasting before Ramadan. Methods: A total of 317 diabetic patients attending the endocrinology clinic at Ghaem Hospital, Mashhad, Iran, participated in this cross-sectional study. The American Diabetic Association (ADA) criteria were applied to diagnose diabetes. Various parameters, including diabetes type and duration, complications, and risk factors were recorded to determine IDF-DAR-based risk. Then patients were stratified into high (IDF-DAR>6), medium (IDF-DAR: 3.5-6) and low (IDF-DAR: 0-3) risk groups accordingly. Results: Out of the 317 patients included in the study, 115 (36.3%) patients were categorized as low risk, 127 (40%) as moderate-risk, and 75 (23.7%) as high-risk groups. Conclusions:  According to the IDF-DAR guideline, majority of the patients fell into the low and moderate risk categories, suggesting that they should not be entirely exempted from fasting during the holy month of Ramadan. However, the validity of this patient stratification in various fasting populations needs to be evaluated through prospective longitudinal studies.

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References

  1. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998; 21(9):1414-31.
  2. Dwyer-Lindgren L, Mackenbach JP, van Lenthe FJ, Flaxman AD, Mokdad AH. Diagnosed and Undiagnosed Diabetes Prevalence by County in the U.S., 1999-2012. Diabetes Care. 2016; 39(9):1556-62.
  3. Lin X, Xu Y, Pan X, Xu J, Ding Y, Sun X, et.al. Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Sci Rep. 2020;10(1):14790.
  4. IDF Diabetes Atlas, 10th edn. Brussels, Belgium: International Diabetes Federation. 2021.

5- Yang JJ, Yu D, Wen W, Saito E, Rahman S, Shu XO, et.al. Association of Diabetes With All-Cause and Cause-Specific Mortality in Asia: A Pooled Analysis of More Than 1 Million Participants. JAMA Netw Open. 2019; 2(4):e192696.

  1. World Health Organiazation. The top 10 causes of death (Accessed 1 May 2019); https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.2018.
  2. Hassanein M, Al-Arouj M, Hamdy O, Bebakar WMW, Jabbar A, Al-Madani A, et.al; International Diabetes Federation (IDF), in collaboration with the Diabetes and Ramadan (DAR) International Alliance. Diabetes and Ramadan: Practical guidelines. Diabetes Res Clin Pract. 2017; 126:303-16.
  3. Pakkir Maideen N-M, Jumale A, Alatrash J. Management of Diabetes Mellitus in Islamic Fasting. J Nutrition Fasting Health. 2019; 7(1): 26-36.
  4. Saeed M, Ali M, Zehra T, Haider Zaidi SA, Tariq R. Intermittent Fasting: A User-Friendly Method for Type 2 Diabetes Mellitus. Cureus. 2021; 13(11):e19348.
  5. Beshyah WS, Beshyah SA. Bibliometric analysis of the literature on Ramadan fasting and diabetes in the past three decades (1989-2018). Diabetes Res Clin Pract. 2019; 151:313-22.
  6. Hassanein M, Afandi B, Yakoob Ahmedani M, Mohammad Alamoudi R, Alawadi F, et.al. Diabetes and Ramadan: Practical guidelines 2021. Diabetes Res Clin Pract. 2022; 185:109185.
  7. Salti I, Bénard E, Detournay B, Bianchi-Biscay M, Le Brigand C, Voinet C, et al. A Population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries results of the Epidemiology of Diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diabet Care. 2004; 27(10):2306-11.
  8. Mohammed N, Buckley A, Siddiqui M, Al Ahmed S, Afandi B, Hassanein M, Lessan N, Suliman M. Validation of the new IDF-DAR risk assessment tool for Ramadan fasting in patients with diabetes. Diabetes Metab Syndr. 2023; 17(4):102754.
  9. Habib SS, Aslam M. Risk factors, knowledge and health status in diabetic patients. Saudi Med J. 2003; 24(11):1219-24.
  10. Angamo MT, Melese BH, Ayen WY. Determinants of glycemic control among insulin treated diabetic patients in Southwest Ethiopia: hospital based cross sectional study. PLoS One. 2013; 8(4):e61759.
  11. Ahmedani MY, Alvi SF, Haque MS, Fawwad A, Basit A. Implementation of Ramadan-specific diabetes management recommendations: a multi-centered prospective study from Pakistan. J Diabetes Metab Disord. 2014; 13(1):37.
  12. Bravis V, Hui E, Salih S, Mehar S, Hassanein M, Devendra D. Ramadan education and awareness in diabetes (READ) programme for Muslims with type 2 diabetes who fast during Ramadan. Diabet Med. 2010; 27(3):327–31.
  13. Kamrul-Hasan ABM, Alam MS, Kabir MA, Chowdhury SR, Hannan MA, Chowdhury EUR, 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. J Clin Transl Endocrinol. 2023; 31:100315.
  14. Ahmed SH, Chowdhury TA, Hussain S, Syed A, Karamat A, Helmy A, et.al. Ramadan and Diabetes: A Narrative Review and Practice Update. Diabetes Ther. 2020; 11(11):2477-520.
  15. Hanif W, Patel V, Ali SN, Karamat A, Saeed M, Hassanein M, et.al. The South Asian Health Foundation (UK) guidelines for managing diabetes during Ramadan. Diabetes Res Clin Pract. 2020; 164:108145.
  16. Hassanein M, Abdelgadir E, Bashier A, Rashid F, Saeed MA, Khalifa A, et.al. The role of optimum diabetes care in form of Ramadan focused diabetes education, flash glucose monitoring system and pre-Ramadan dose adjustments in the safety of Ramadan fasting in high risk patients with diabetes. Diabetes Res Clin Pract. 2019; 150:288-95.
Journal of Nutrition,Fasting and Health
Volume 12, Issue 1
March 2024
Pages 14-19

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History

  • Receive Date: 14 November 2023
  • Revise Date: 16 December 2023
  • Accept Date: 18 December 2023

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