Changing how we risk-categorise in Ramadan: does the IDF-DAR scoring system achieve the requirements for people with diabetes internationally?

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Authors
Dabhad, Ammarah
Issue Date
2021-04-24
Type
Article
Peer-Reviewed Publication
Keywords
Blood glucose
Blood glucose self-monitoring
Diabetes
Diabetes mellitus
Fasting
Female
Guideline
Hypoglycemic agents
Islam
Male
Ramadan
Type 2 diabetes mellitus
Journal
Diabetes Research and Clinical Practice
Volume
Issue
Research Projects
Organizational Units
Journal Issue
Alternative Title
Abstract
The IDF-DAR guidance was most recently updated this year. The most notable change is the moving to a scoring system from a tabulated risk categorization to determine and classify the risk of harm from fasting derived from an online survey. This change may be appealing and is welcomed. However, such a system and the methodology underpinning it is not without limitations. This commentary highlights some of these limitations and the associated limited safe options available to individuals with diabetes desiring to fast during Ramadan. Overlooked clinical considerations that deserve formal recognition include the role of technology (aspects relating to glucose monitoring and/or insulin delivery) and previous experience of safe Ramadan fasting. Further, duration of fast (which can almost double in temperate regions from winter to summer) needs greater emphasis. We also advocate separate scoring systems for people with type 1 diabetes and complex type 2 diabetes. The guidance acknowledges fasting is an individual's decision, however the general message needs to be more person-centred and currently only presents a binary approach to fasting - all or nothing choices. We propose and discuss addition options including, trial fasting of voluntary fasts, starting the fast and terminating due to health and/or safety, intermittent fasting and winter fasting.
Citation
Ghouri N, Hussain S, Ahmed SH, Beshyah SA, Rashid R, Al-Ozairi E, Waqar S, Dabhad A, Mohammed R. Changing how we risk-categorise in Ramadan: Does the IDF-DAR scoring system achieve the requirements for people with diabetes internationally? Diabetes Res Clin Pract. 2021 Apr 23:108835. doi: 10.1016/j.diabres.2021.108835. Epub ahead of print. PMID: 33901626.
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