Background:

The International Diabetes Federation-Diabetes and Ramadan (IDF-DAR) Practical Guidelines 2021 provide a risk stratification tool to guide the assessment of people with diabetes before they observe Ramadan. Here we conducted a survey study to explore the predictability of the IDF-DAR 2021 guidelines, and the factors associated with breaking fast, in people with type 1 diabetes (PwT1D) during Ramadan.

Methods:

This cross-sectional study included adult PwT1D living in Saudi Arabia, aged 18 years and above, who observed Ramadan 2022. Between May and August 2022, a standardized online questionnaire was used to collect data regarding socio-demographics, medical history (including the modality of T1D management and other components of the IDF-DAR risk calculator), and Ramadan fasting experience.

Results:

The study included 963 PwT1D (257 males and 706 females, mean age 26.5 ± 8.4 years). Applying the IDF-DAR risk calculator revealed that the study respondents included 66% high-risk PwT1D, 34% moderate-risk PwT1D (34%), and no low-risk PwT1D. Compared to the moderate-risk group, the high-risk group had significantly more days during which fasting was broken, a higher prevalence of diabetes complications, and more frequent diabetes-related ER visits (P < .01). Attending a pre-Ramadan education session was associated with 47% lower odds of visiting the ER during Ramadan (odds ratio 0.53; 95% confidence interval 0.34-0.82; P = .005).

Conclusion:

The IDF-DAR 2021 risk calculator predicts the risk of acute diabetes complications and ER visits during Ramadan fasting. Pre-Ramadan education sessions are important and may reduce acute complications among PwT1D during Ramadan fasting.

Plain Language Summary

Assessment of Fasting Risk Assessment Tool to Predict Type 1 Diabetes-Related Complications During Ramadan: Ramadan fasting poses challenges for people with type 1 diabetes PwT1D, a condition requiring careful blood sugar control due to lack of insulin. In 2021, the International Diabetes Federation issued guidelines to help assess fasting risks. Since many PwT1D fast despite potential dangers, this study evaluated how well the guidelines predict complications and what factors influence early fast-breaking. An online survey was conducted between May and August 2022 among 963 adults (mean age 27 years; 73% women) with type 1 diabetes in Saudi Arabia who fasted during Ramadan. Using the guidelines’ risk tool, 66% were classified as high-risk and 34% as moderate risk. High-risk individuals experienced more fasting interruptions, diabetes-related issues, and emergency room visits. Notably, those who received pre-Ramadan education were about 50% less likely to require emergency care. Findings suggest the 2021 guidelines are effective in identifying those at-risk during Ramadan, and pre-fasting education significantly improves safety outcomes.

Search results

Assessment of the IDF-DAR Fasting Risk Assessment Tool to Predict Type 1 Diabetes-Related Complications During Ramadan in a Real-World Setting