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

Table 4 The International Diabetes Federation-Diabetes and Ramadan risk assessment tool (2021) for people with diabetes intending to fast during Ramadan

International Diabetes Federation-Diabetes and Ramadan risk assessment tool
Section A: Narrative risk factors and numerical risk scores
Risk element	Score
(1) Diabetes type
T1D	1
T2D	0
(2) Diabetes duration
≥ 10 years	1
< 10 years	0
(3) Hypoglycemia
Hypoglycemia unawareness	6.5
Recent severe hypoglycemia	5.5
Multiple weekly hypoglycemia	3.5
Hypoglycemia less than 1 time per week	1
No hypoglycemia	0
(4) HbA1c
> 9% (11.7 mmol/L)	2
7.5%-9% (9.4–11.7 mmol/L)	1
< 7.5% (9.4 mmol/L)	0
(5) Type of treatment
Multiple daily mixed insulin injections	3
Basal bolus/insulin pump	2.5
Once daily, mixed insulin	2
Basal insulin	1.5
Glibenclamide	1
Gliclazide/MR or glimepride or repeglanide	0.5
Other therapies, excluding sulfonylureas or insulin	0
(6) Self-monitoring of blood glucose
Indicated but not conducted	2
Indicated but conducted suboptimally	1
Conducted as indicated	0
(7) Acute complications
DKA/HHS in the last 3 months	3
DKA/HHS in the last 6 months	2
DKA/HHS in the last 12 months	1
No DKA/HHS	0
(8) MVD
Unstable MVD	6.5
Stable MVD	2
No MVD	0
(9) Renal function status
eGFR < 30 mL/min	6.5
eGFR 30-45 mL/min	4
eGFR 45-60 mL/min	2
eGFR > 60 mL/min	0
(10) Pregnancy
Pregnant not within targets	6.5
Pregnant within targets	3.5
Not pregnant	0
(11) Frailty and cognitive function
Impaired cognitive function or frail	6.5
> 70 years old with no home support	3.5
No frailty or loss in cognitive function	0
(12) Physical labor
Highly intense	4
Moderate intense	2
None	0
(13) Previous Ramadan experience
Overall negative experience	1
No negative or positive experience	0
(14) Fasting hours
≥ 16 hours	1
< 16 hours	0
Section B: Sum of risk scores and their corresponding categories
Score 0-3	Low risk
Score 3.5-6	Moderate risk
Score > 6	High risk

DKA: Diabetic ketoacidosis; HbA1c: Glycosylated hemoglobin; HHS: Hyperglycemic hyperosmolar states; eGFR: Estimated glomerular filtration rate; MVD: Macrovascular disease.