Risk Assessment for Ramadan Fasting in People With Diabetes in Hospital-Based Diabetes Clinics Using the Updated 2026 IDF-DAR Risk Calculator
- Author:
Raja Nurazni Raja Azwan
1
;
Chin Voon Tong
1
;
Lisa Mohamed Nor
1
;
Marisa Khatijah Borhan
2
;
Syarifah Syahirah Syed Abas
3
;
Poh Shean Wong
4
;
Ying Jie Tan
5
;
Shartiyah Ismail
6
;
Eunice Yi Chwen Lau
7
;
Yueh Chien Kuan
8
;
Noor Hafis Md Tob
9
;
Shu Teng Chai
10
;
Pei Lin Chan
11
;
Xe Hui Lee
12
;
Wei Wei Ng
13
;
Jin Hui Ho
14
;
Miza Hiryanti Zakaria
15
;
Rabeah Md Zuki
16
;
Wan Mohd Hafez Wan Hamzah
17
;
Melissa Vergis
18
;
Choon Peng Sun
19
;
Vanusha Devaraja Pillai
20
;
Chee Koon Low
21
;
Shazatul Reza Mohd Redzuan
22
;
Xin-Yi Ooi
23
;
Siti Sanaa Wan Azman
24
;
Deviga Lachumanan
25
;
Saiful Shahrizal Shudim
26
;
Zanariah Hussein
1
Author Information
- Publication Type:Journal Article
- MeSH: Risk Assessment; Diabetes Mellitus; Hospitals; Fasting
- From: Journal of the ASEAN Federation of Endocrine Societies 2026;41(S1):42-43
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:The 2021 IDF-DAR risk calculator had been previously
evaluated in multiple studies and subsequently widely
accepted and applied in clinical practice as a practical
standardized tool for patient risk stratification. Recently
updated, the 2026 IDF-DAR Risk calculator enables a more individualized, evidence-related evaluation of patientrelated and disease-related risk factors, incorporating
modern diabetes technologies, including continuous
glucose monitoring (CGM), automated insulin delivery
(AID) systems, and advanced insulin formulations to
enhance risk stratification. This tool allows medical
professionals to tailor Ramadan practices based on overall
factors toward promoting safe fasting.
Methodology:This prospective multicentre observational study recruited adults with Type 1 and Type 2 diabetes attending public hospitals nationwide. People with diabetes (PwD) intending to perform Ramadan fasting were invited to participate and assessed using the 2026 IDF-DAR Risk Calculator in the 6-week pre-Ramadan period between 30th January and 19th March 2026.
Results:A total of 458 PwD were evaluated and stratified into low (15.7%), moderate (41%), and high risk (43.3%) categories. Most participants had Type 2 diabetes (83.6%), with 60.3% having a disease duration exceeding 10 years and 43% exhibiting poor glycemic control (hemoglobin A1c >9%). Insulin therapy was used by 76.4% of participants, including two individuals with Type 1 diabetes using AID systems. Most participants reported no recent hypoglycemia (76.4%), 81.0% performed glucose monitoring, and 3.3% used CGM. Severe comorbidities were uncommon, with 1.1% having unstable macrovascular disease and 4.4% advanced chronic kidney disease (estimated glomerular filtration rate <30). Notably, 72.2% received structured Ramadan education.
Conclusion:Majority of PwD attending tertiary diabetes clinics were in the moderate- to high-risk category and intended to fast despite medical advice against fasting in some cases. Although most participants were on insulin therapy, hypoglycemia was low in the pre-Ramadan period. Integration of modern technologies, advanced insulin therapies, and structured education may support safer fasting practices. - Full text:2026072917263951370EP_A042.pdf
