Pre-Ramadan assessment and Risk calculation for people with diabetes who want to fast during Ramadan
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Pre-Ramadan assessment in patients with diabetes who want to fast
Pre-assessment should take place 6–8 weeks before Ramadan and should review:
- Diabetes type and duration
- Diabetes medication
- Complications and/or comorbidities
- Hypoglycaemia risk
- Previous experience during Ramadan
- Ability to self-manage diabetes
- Social and work circumstances
Prior to Ramadan, patients should also receive structured education on:
- Role of SMBG
- Fluid intake
- Meal planning
- When to exercise
- Medication adjustments
- Risk quantification
- When to break the fast
SMBG, self-monitoring of blood glucose Diabetes and Ramadan: Practical Guidelines International Diabetes Federation (IDF), in collaboration with the Diabetes and Ramadan (DAR) International Alliance. January 2021. Available at: www.idf.org/news/idf-dar-diabetes-in-ramadan guidelines
Risk calculation and suggested risk score for people with diabetes who want to fast during Ramadan
| Total score | Category |
| 0 to 3 | Low risk |
| 3.5 to 6 | Moderate risk |
| >6 | High risk |
| Diabetes type and duration | ||
| Score | ||
| Type 1 diabetes | 1 | |
| Type 2 diabetes | 0 | |
| A duration of ≥10 years | 1 | |
| A duration of <10 years | 0 | |
| Acute complications | ||
| Score | ||
| DKA/HONC in the last 3 months | 3 | |
| DKA/HONC in the last 6 months | 2 | |
| DKA/HONC in the last 12 months | 1 | |
| No DKA or HONC | 0 | |
| Physical Labour | ||
| Score | ||
| Highly Intense physical labour | 4 | |
| Moderate Intense Physical Labour | 2 | |
| No physical labour | 0 | |
| Fasting hours (location) | ||
| Score | ||
| ≥16 hours | 1 | |
| <16 hours | 0 | |
| Presence of hypoglycaemia | ||
| Score | ||
| Hypoglycaemia unawareness | 6.5 | |
| Recent Severe hypoglycaemia | 5.5 | |
| Multiple weekly Hypoglycaemia | 3.5 | |
| Hypoglycaemia less than 1 time per week | 1 | |
| No hypoglycaemia | 0 | |
| MVD Complications/Comorbidities | ||
| Score | ||
| Unstable MVD | 6.5 | |
| Stable MVD | 2 | |
| No MVD | 0 | |
| Renal Complications/Comorbidities | ||
| Score | ||
| eGFR < 30 mL/min | 6.5 | |
| eGFR 30–45 mL/min | 4 | |
| eGFR 45–60 mL/min | 2 | |
| eGFR >60 mL/min | 0 | |
| Self-Monitoring of Blood Glucose (SMBG) | ||
| Score | ||
| Indicated but not conducted | 2 | |
| Indicated but conducted sub-optimally | 1 | |
| Conducted as indicated | 0 | |
| Level of glycaemic control | ||
| Score | ||
| HbA1c >9% (11.7 mmol/L) | 2 | |
| HbA1c 7.5–9% (9.4–11.7 mmol/L) | 1 | |
| HbA1c <7.5% (9.4 mmol/L) | 0 | |
| Pregnancy* | ||
| Score | ||
| Pregnant not within targets* | 6.5 | |
| Pregnant within targets* | 3.5 | |
| Not pregnant | 0 | |
| Frailty and Cognitive function | ||
| Score | ||
| Impaired cognitive function or Frail | 6.5 | |
| > 70 years old with no home support | 3.5 | |
| No frailty or loss in cognitive function | 0 | |
| Previous Ramadan Experience | ||
| Score | ||
| Overall negative experience | 1 | |
| No negative or positive experience | 0 | |
| Type of treatment | ||
| Score | ||
| 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 therapy not including SU or insulin | 0 | |
|
DKA — Diabetic Ketoacidosis *Pregnant and breastfeeding women have the right to not fast regardless of whether they have diabetes |
| Total score | Category |
| 0 | Low risk |
| Reset |
Abbreviation
CVD, cardiovascular disease; DKA, diabetic ketoacidosis; eGFR, estimated glomerular filtration rate; HONC, hyperglycaemic hyperosmolar non-ketotic coma; MR, modified release; SMBG, self-monitored blood glucose; SU, sulphonylurea
Diabetes and Ramadan: Practical Guidelines International Diabetes Federation (IDF), in collaboration with the Diabetes and Ramadan (DAR) International Alliance. January 2021. Available at: https://daralliance.me/guidelines
