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International Diabetes Federation-Diabetes and Ramadan Alliance (IDF-DAR) Fasting Risk Assessment

Stratifies fasting risk during Ramadan in diabetic patients.

Diabetes type

Years since diabetes diagnosis

Presence of hypoglycemia

Level of glycemic control

Type of treatment

Self-monitoring of blood glucose (SMBG)

Acute complications

MVD complications/comorbidities

Renal complications/comorbidities

Pregnancy

Frailty and cognitive function

Physical labor

Previous Ramadan experience

Fasting hours

Result:

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Advice
Risk CategoryMedical Designation
Low riskFasting is probably safe.
Moderate riskFasting safety is uncertain.
High riskFasting is probably unsafe.
Management
  • Fasting is a personal decision. 

  • Provide education on recognizing hypoglycemia and hyperglycemia symptoms.

  • Regardless of a patient’s risk group, patients should be counseled to break their fast if they experience hypoglycemia episodes.

  • Encourage close monitoring of glucose levels during fasting hours. Emphasize that glucose testing during Ramadan does not break the fast.

  • Adjustment of the patient’s diabetes treatment plan may be required to avoid adverse events during fasting.

  • Allow flexibility in glycemic targets during Ramadan.

  • Consider a medical nutrition consultation.

  • For additional guidance, see the ADA/EASD consensus recommendations for management of diabetes during Ramadan here or the Diabetes and Ramadan practical guidelines here.