A TERTIARY CENTER EXPERIENCE IN USING THE 2021 IDF-DAR RISK CALCULATOR FOR PEOPLE WITH DIABETES BEFORE RAMADAN

Abstract

INTRODUCTION
Fasting during Ramadan carries considerable risks for patients with diabetes. Risk stratification identifies those at high risk for complications and guides our recommendations against fasting. Evolving from previous guidelines, the 2021 International Diabetes Federation - Diabetes and Ramadan (IDF-DAR) risk stratification system seeks to enable more personalized risk assessment by objectively evaluating 14 Ramadan-, disease- and patient-related risk variables.

METHODOLOGY
We used the new IDF-DAR risk calculator in Muslim patients with diabetes who attended usual follow-up at the diabetes clinic in Hospital Putrajaya starting five weeks prior to Ramadan 2021. Their intention to fast, baseline diabetes therapy and planned treatment adjustments for Ramadan were recorded. We also assessed the acceptance of this new tool among the attending doctors.

RESULTS
We assessed 210 patients (93.8% type 2 diabetes). Mean age was 54.6 years (range 16 to 82 years) and 59.5% were females. Majority had long-standing diabetes (69% ≥10 years), insulin-treated (69.5%) and had poor glycaemic control (57.6% with HbA1c ≥7.5%). Most were stratified into high (40.5%) and moderate risk (33.3%) categories which recommend against Ramadan fasting. Despite this, intention to fast was 98.6% and 81.2% in moderate and high risk patients, respectively. Of the 17 who opted not to fast, 94% (n=16) were assessed as high risk, 53% experienced hypoglycaemia and 35.2% had prior negative fasting experience. Attending doctors found the risk calculator to be simple and quick to administer.

CONCLUSION
The new IDF-DAR risk calculator is a comprehensive easy-to-use tool that considers numerous elements to provide a more complete and objective quantification of a patient’s risk for complications during Ramadan. Intention to fast remains very high among those in high risk category. Attending doctors need to ensure appropriate recommendations against fasting are emphasized and practiced to reduce complications during Ramadan.