Validity of the International Diabetes Federation risk stratification score of Ramadan fasting in individuals with diabetes mellitus

Eman M. Alfadhli; Taif S. Alharbi; Abrar M. Alrotoie; Asia A. Aljohani; Amal S. Qari; Bashaer A. Alsubhi; Aram H. Alsaedi; Alaa A. Aljohani

doi:10.15537/smj.2024.45.1.2023060

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Figure 1
- Frequency of hypoglycemic medications use in type 2 diabetes mellitus group (n=370). DPP4: dipeptidyl peptidase-4 inhibitor, SGLT2I: sodium-glucose cotransporter-2, GLP1-A: glucagon-like peptide-1 agonist, TZD: thiazolidinediones
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Figure 2
- Timing of breaking the fast.

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Table 1

- Baseline characteristics of the whole group and each risk group category (N=466).

Variables	All patients	IDF-DAR risk stratification			P-values
Variables	All patients	Low risk (n=86)	Moderate risk (n=115)	High risk (n=265)	P-values
Age (years)	49.0±16.9	53.8±13.1	48.7±15.5	47.5±18.3	0.011
HbA1c	8.7±1.8	7.6±1.5	8.8±1.7	9.0±1.7	0.000
e-GFR	93.2±30.1	87.21±26.7	94.5±26.9	94.6±32.3	0.115
Duration of diabetes (years)	11.6±8.2	7.3±5.5	10.0±7.9	13.6±8.3	0.000
Type 1 diabetes	96 (20.6)	2 (2.1)	13 (13.5)	81 (84.4)	0.000
Type 2 diabetes	370 (79.4)	84 (22.7)	102 (27.6)	184 (49.7)	0.000

Values are presented as numbers and precentages (%) or mean ± standard deviation (SD).

IDF-DAR: International Diabetes Federation-Diabetes and Ramadan International Alliance, HbA1c: hemoglobin A1c, e-GFR: estimated glomerular filtration rate

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Table 2

- Association between International Diabetes Federation-Diabetes and Ramadan International Alliance risk stratification score and Ramadan fasting in individuals with diabetes (N=466).

Factors	All patients (N=466)	IDF-DAR risk stratification			P-values
Factors	All patients (N=466)	Low risk (n=86)	Moderate risk (n=115)	High risk (n=265)	P-values
Fast all days of Ramadan	298 (63.9)	76 (88.4)	81 (70.4)	14 (53.2)	0.000
Did not fast the whole month of Ramadan	168 (36.1)	10 (11.6)	34 (29.6)	124 (46.8)	0.000
Diabetes related causes for non-fasting	106 (22.4)	4 (4.7)	18 (15.7)	84 (31.7)	0.000
Hypoglycemia	95 (20.4)	4 (4.7)	16 (13.9)	75 (28.3)	0.000
Hyperglycemia	27 (5.8)	1 (1.2)	4 (3.5)	22 (8.3)	0.023
DKA	1 (0.2)	0 (0.0)	0 (0.0)	1 (0.4)	0.684
Number of non-fasting days	3.01±6.7	0.63±2.0	2.03±5	4.2±8	0.000
Admission to the hospital during Ramadan	10 (2.1)	0 (0.0)	0 (0.0)	10 (3.8)	0.021

Values are presented as numbers and precentages (%) or mean ± standard deviation.

IDF-DAR: International Diabetes Federation-Diabetes and Ramadan International Alliance, DKA: diabetic ketoacidosis

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Table 3

- Binomial logistic regression for the association between non-fasting all days of Ramadan and International Diabetes Federation-Diabetes and Ramadan International Alliance risk stratification score (N=466).

IDF-DAR risk stratification score	Odds ratio	P-values	95% CI
IDF-DAR risk stratification score	Odds ratio	P-values	Lower	Upper
High risk versus moderate risk	2.09	0.002	1.31	3.34
Moderate risk versus low risk	3.19	0.003	1.48	6.90
High risk versus low risk	6.69	0.000	3.31	13.49

IDF-DAR: International Diabetes Federation - Diabetes and Ramadan Alliance, CI: confidence interval

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Table 4

- Association between diabetes type and International Diabetes Federation-Diabetes and Ramadan International Alliance risk stratification with fasting Ramadan (N=466).

Factors	Diabetes type		P-values
Factors	T1DM (n=96)	T2DM (n=370)	P-values
Age (years)	24.2±8.1	55.4±11.9	0.000
Duration of diabetes (years)	11.4±7.3	11.6±8.3	0.880
HbA1c	8.8±1.7	8.6±1.8	0.211
IDF-DAR risk stratification
Low risk	2 (2.1)	84 (22.7)	0.000
Moderate risk	13 (13.5)	102 (27.6)
High risk	81 (84.4)	18 (49.7)
Fast all days of Ramadan	13 (13.5)	285 (77.0)	0.000
Did not fast the whole month of Ramadan	83 (86.5)	85 (23.0)	0.000
Diabetes related causes for non-fasting	59 (61.5)	4 (12.7)	0.000
Hypoglycemia	54 (56.1)	41 (11.1)	0.000
Hyperglycemia	18 (18.8)	9 (2.4)	0.000
DKA	1 (1.0)	0 (0.0)	0.050
Admission to the hospital	3 (3.1)	7 (1.9)	0.459
Breaking the fasting in the first 5 hours of the day	2.1±4.4	0.21±0.6	0.000
Breaking the fasting from 5 hours until 10 hours	1.02±2.1	0.84±2.1	0.600
Breaking the fasting after more than 10 hours	0.75±2.1	0.67±1.5	0.757

Values are presented as numbers and precentages (%) or mean ± standard deviation (SD).

T1DM: type 1 diabetes mellitus, T2DM: type 2 diabetes mellitus, HbA1c: hemoglobin A1c, IDF-DAR: International Diabetes Federation - Diabetes and Ramadan Alliance, DKA: diabetic ketoacidosis