Evolution of the risk concept and assessment tools for diabetes during Ramadan fasting: A narrative review

Table 2 Factors contributing to risk of complications during Ramadan fasting

Category	Contributing factors
Ramadan-specific	Length of fasting hours1. Season and climate (temperature/humidity). Geographic location
Diabetes-specific	Type of diabetes (T1D > T2D risk). Duration of diabetes. Level of control (tight or poor)2. Presence of complications. Type of therapy (e.g., insulin, sulfonylureas)3. Proneness to hypoglycemia. Hypoglycemia unawareness
Individual and social-related	Age (higher risk in adolescents and elderly). Sex. Occupation (e.g., physical labor). Pregnancy/Lactation. Frailty/cognitive impairment. Motivation and cultural beliefs. Access to care and self-monitoring tools. Family and social support. Prior fasting experience

¹Duration of fasting is between dawn and sunset, which is dependent on the location and time of year.

²Both poor control (e.g., HbA1c > 9%) and very tight control increase fasting-related risks.

³Hypoglycemia during Ramadan fasting in those receiving insulins and sulphonylureas in general than in more modern medications such as SGLT2 inhibitors, DDP4 inhibitors and GLP-1 RA.

T1D: Type 1 diabetes; T2D: Type 2 diabetes.