Validity of the New International Diabetes Federation-Diabetes and Ramadan (IDF-DAR) Risk Stratification Score and Fasting Experience of Saudi Patients With Diabetes During Ramadan: Insights From a Cross-Sectional Study

Background The International Diabetes Federation-Diabetes and Ramadan (IDF-DAR) risk stratification tool is designed to predict adverse outcomes in patients with diabetes who fast during Ramadan. Objectives This study evaluates the accuracy of the IDF-DAR tool in predicting adverse outcomes among Saudi patients with diabetes intending to fast during Ramadan while comparing outcomes across different risk categories. Methods This prospective observational study was conducted at the Obesity, Endocrine, and Metabolism Center, King Fahad Medical City, and diabetes clinics at King Abdulaziz Medical City in Riyadh, Saudi Arabia. Data were collected through questionnaires on diabetes characteristics, complications, comorbidities, and factors influencing fasting. Ordinal regression analysis was performed to identify predictors of risk levels. Results The cohort consisted of 303 patients, including 163 females (53.5%) with a mean age of 50.49 ± 17.91 years. Type 2 diabetes mellitus was diagnosed in 217 participants (71.6%), and 231 patients (76.2%) had diabetes for over 10 years. Risk stratification categorized 39 patients (12.9%) as low risk, 71 (23.4%) as moderate risk, and 193 (63.7%) as high risk. Self-monitoring of blood glucose adherence was reported in 174 patients (57.4%), with the highest adherence in the high-risk group (126 or 65.3%) and the lowest in the low-risk group (18 or 46.2%). Hyperglycemia (>16.6 mmol/L) was observed in 141 participants (47%): 13 (33.3%) low risk, 26 (36.6%) moderate risk, and 103 (53.4%) high risk. Hypoglycemia was the most common reason for breaking the fast, notably among 23 patients (71.9%) fasting for more than 15 days. A significant majority of participants aimed to fast for the full 30 days, with the highest completion rate among moderate-risk individuals at 58 (81.7%). In contrast, 27 individuals (14.92%) in the high-risk group did not fast at all. Conclusions The IDF-DAR tool effectively stratifies fasting risk in diabetic patients but may not accurately reflect the risk for some high-risk individuals. Further validation is necessary to enhance its predictive accuracy.