Validation of the new IDF-DAR risk assessment tool for Ramadan fasting in patients with diabetes in a primary healthcare setting.

Abstract

Background: In diabetic patients intending to fast, Ramadan, risk assessment, and stratification are essential for an individualized treatment plan. The new IDF-DAR risk stratification tool (International Diabetes Federation - Diabetes and Ramadan Alliance) is becoming the primary tool. This study aims to validate this tool in the Abu Dhabi population. Method IDF-DAR risk stratification assessment was done before Ramadan, followed by assessing any significant outcome after Ramadan. Patients were included if the attending physicians used the tool in the risk assessment of the patients within six weeks before Ramadan 1444, 2022, in the AHS healthcare center. After Ramadan, assessment was done through tele-interview and Electronic Medical Records review. Results Patients included in the study were 435, excluding 21 patients with type 1 Diabetes. Half of the patients were in the low-risk category of the IDF-DAR risk stratification tool (51.7%), 28.5% in the moderate-risk category, and 19.8% in the higher-risk category. Most of those patients fasted all of Ramadan, 81.3%, and the remaining 28.7% attempted to fast but had to break their fast; among them, only 17 (3.9%)did not fast for 15 days or more. The lower-risk group was younger, with an average age of 56.3 years, compared to the moderate and high-risk risk, who had an average age of 59 and 64.5 years, respectively. Diabetes control was progressively worse with increasing the DAR risk category with an average HbA1C of 7.18, 8.2, and 9 for the low, moderate, and high-risk categories. From all the sample, 14 (3.8%) were admitted at least once, and 56 (12.9%) had at least one significant event, including admission to the hospital. Using logistic regression, the determinant factor of not having an adverse event was fasting more days, B=-0.08 OR=0.92 (0.86-0.99) p value=0.023. Another independent risk factor was being in the low-risk category of the DAR risk assessment tool B=-1.2, OR= 0.29 (0.09-0.95)p value=0.042 and having a higher frailty score was the third independent risk factor, B=0.4, OR=1.5 (1-2.02-1.86) p value=0.039. Conclusion Diabetic patients in the Low-risk category, according to the IDF-DAR risk assessment, had a better outcome than the Moderate or high-risk categories during Ramadan regarding significant adverse events. Another independent risk factor is if the patient is Frail, according to the FRAIL scoring.