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CC BY 4.0 · Journal of Diabetes and Endocrine Practice
DOI: 10.1055/s-0045-1809385
Original Articles

Impact of the IDF-DAR Risk Stratification and Pre-Ramadan Education on Diabetes-Related Complications

Ali Al Reesi 
1   Internal Medicine Department, Endocrinology and Diabetes Unit, Suhar Hospital, Ministry of Health, Suhar, Oman
2   Department of Internal Medicine, College of Medicine and Health Sciences, National University of Science and Technology, Muscat, Oman
,
Hamed Al Reesi
3   Department of Studies and Research, Directorate General of Health Services-NBG, Ministry of Health, Suhar, Oman
,
Salem Al Ghaithi
1   Internal Medicine Department, Endocrinology and Diabetes Unit, Suhar Hospital, Ministry of Health, Suhar, Oman
,
Ibrahim Al Ali 
1   Internal Medicine Department, Endocrinology and Diabetes Unit, Suhar Hospital, Ministry of Health, Suhar, Oman
,
Sheikha Al Siyabi
4   Sur Polyclinic, Ministry of Health, Oman
,
Salwa Al Balushi
5   Falaj Al-Qabial Health Center, Ministry of Health, Oman
,
Ameet Kumar
4   Sur Polyclinic, Ministry of Health, Oman
,
Maryam Al Maqbali
1   Internal Medicine Department, Endocrinology and Diabetes Unit, Suhar Hospital, Ministry of Health, Suhar, Oman
,
Malouk Al Eidi
1   Internal Medicine Department, Endocrinology and Diabetes Unit, Suhar Hospital, Ministry of Health, Suhar, Oman
,
Khalid Mohammed Ali
2   Department of Internal Medicine, College of Medicine and Health Sciences, National University of Science and Technology, Muscat, Oman
› Author Affiliations
Funding and Sponsorship This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Abstract

Background

Ramadan, the ninth month of the Islamic lunar calendar, requires Muslims to fast from dawn to sunset. However, fasting during this holy month can be challenging, particularly for individuals with chronic diseases like diabetes mellitus.

Objectives

This study aims to assess the validity of the new International Diabetes Federation-Diabetes and Ramadan International Alliance (IDF-DAR) risk stratification tool for Ramadan fasting in predicting persons with diabetes' ability to fast safely and assess the impact of well-structured pre-Ramadan education in helping patients to fast safely and reducing fasting-associated complications.

Methods

This prospective observational study was carried out in three diabetes centers in Oman from January to March 2024. All eligible patients seeking diabetes care in the study settings were invited. They were provided with a prefasting risk assessment and introduced to a well-structured educational program with a follow-up during and after Ramadan to record progress conditions. Variables were statistically described, and the hypotheses were tested at a 5% significance level using SPSS, version 23.

Results

IDF-DAR stratification revealed a significant difference in diabetes type and a significant correlation with hemoglobin A1c levels. Half (51%) of patients with type 1 diabetes mellitus managed to fast the entire month compared to the majority (89%) of those with type 2 diabetes mellitus. Breaking the fast was more often associated with hypoglycemia (37%) and hyperglycemia (20.5%). Only 1.9% of patients required hospitalization during Ramadan, mainly due to diabetic ketoacidosis.

Conclusion

The IDF-DAR risk stratification has proven to be a reliable and valid tool for predicting the risk of adverse fasting events in patients with diabetes. Pre-Ramadan education plays a vital role in minimizing fasting-related complications.

Keywords

diabetes - Ramadan - IDF-DAR risk stratification - hypoglycemia - hyperglycemia - DKA

Authors' Contributions

Conception, data collections, or design: A.A.R., H.A.R., S.A.G., I.A.A., M.A.M., M.A.E., S.A.B., S.A.S., A.K., K.M.A.


Acquisition, analysis, or interpretation of data: H.A.R.


Drafting the work or revising: A.A.R., H.A.R., K.M.A.


Final approval of the manuscript: A.A.R, H.A.R.


Compliance with Ethical Principles

This research was approved by from the MoH research committee (MOH/CSR/24/28022). Informed consent was obtained from all patients with a clear explanation of their privacy, confidentiality, and voluntary participation.




Publication History

Article published online:
06 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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