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

Table 3 Evolution of the concept of risk assessment in diabetes and Ramadan fasting

Phase	Timeframe	Approach	Representative sources
Dichotomy model Pre-	1988	Medical interpretations for religious commentaries “Fatwas”: To fast or not to fast	Anecdotal medical translations of the general religious guidance: Fasting allowed vs not allowed from first safety principles
Medical model	1988-2002	Tripartite clinical categorization: Fasting allowed, relative/absolute contraindications	Sulimani et al[7], 1988; Kadiki et al[8], 1989
Narrative risk assessment	2005-2020	Risk tiers: Low, moderate, high, very high; qualitative criteria	Al-Arouj et al[13], 2005; Hassanein et al[14], 2017
Quantitative risk assessment	2021-present	Calculator-based, point system with numeric thresholds and three categories	IDF-DAR Risk Assessment Tool Hassanein et al[15], 2022
Validation	2021-2025	Multi-country evaluation and real-world utility testing of the IDF-DAR tool	Studies from Bahrain, Saudi Arabia, United Arab Emirates, Bangladesh, Oman, Sudan

IDF-DAR: International diabetes federation-diabetes and Ramadan.