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CC BY 4.0 · Journal of Diabetes and Endocrine Practice 2026; 09(01): 029-038
DOI: 10.1055/s-0046-1815925
Original Article

Predictive Ability and the Clinical Validity of IDF-DAR Risk Score and Its Elements among Fasting People with Diabetes during Ramadan

Authors

  • Sanobia Yousuf

    1   Department of Research, Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan

  • Muhammad Yakoob Ahmedani

    2   Department of Diabetology, Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan
    3   Department of Diabetology, Tabba Heart Institute, Karachi, Pakistan

  • Shagufta Zia

    4   Department of Medicine, AIMS Sugar Hospital, Peshawar, Pakistan

Conflict of Interest The authors declare that there are no conflicts of interest regarding the publication of this paper.
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Abstract

Background and Aims

This article aims to determine the predictive ability and the clinical validity of the IDF-DAR risk score and its elements among fasting people with diabetes during Ramadan.

Methods

This prospective observational study was conducted from March to May 2022 at the Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan, with two participating centers from Peshawar (PAK) and Dubai (UAE). People with diabetes who intended to fast were recruited and categorized according to the IDF-DAR risk score. Fasting status and outcomes were assessed post-Ramadan.

Results

A total of 953 fasting people with diabetes participated, of whom 542 (56.9%) were low, 254 (26.7%) moderate, and 157 (16%) high risk. Hypoglycemia occurred in 48 (30.1%) participants in the high-risk group compared with 33(6%) in the low-risk and 17 (6.6%) in the moderate-risk groups. Hyperglycemia was reported in 18 (3.3%) low-risk, 24 (9.4%) moderate-risk, and 24 (15.3%) high-risk participants. Hospitalization occurred in 3 (1.2%) participants in the moderate-risk group. Breaking of fast was most frequent among those with high-risk scores, affecting 20 (12.7%) participants. On multivariate analysis, type 1 diabetes (T1DM) and stage-3 chronic kidney disease (CKD) were the significant predictors of adverse events during fasting, with adjusted odds ratios of 8.33 (95% CI: 4.5–15.45; p < 0.0001) and 3.01 (95% CI: 1.08–8.39; p = 0.035), respectively.

Conclusion

Our study supports the predictive ability and clinical validity of the IDF–DAR risk score. High-risk scores acquired by nonmodifiable factors, such as T1DM and stage-3 CKD, require careful consideration, while optimizing modifiable factors can lower the score and enable safer fasting.

Keywords

Ramadan fasting - IDF-DAR risk score - acute complications - chronic kidney disease - type 1 diabetes

Declaration of Financial/Other Relationships

The authors report no financial or personal relationships that could have affected the conduct or outcomes of this research.


Details of the Earlier Presentation

Preliminary data of this study were presented at the International Diabetes Federation Congress 2022 (December 4–7, Lisbon, Portugal).


Authors' Contributions

S.Y.: Concept and design, data collection, data interpretation, and writing the manuscript.

M.Y.A.: Concept and design, interpretation of data, editing, and reviewing the manuscript.

S.Z.: Responsible for data collection and management in her respective areas, reviewed and approved the final manuscript.


Ethical Approval Statement

The study adhered to the ethical principles outlined in the Declaration of Helsinki (revised 2013). Ethical approval was taken from the Institutional Review Board (IRB) of BIDE (IRB-BIDE/MYAHMEDANI/-07–21–20–009). For the collaborating centers, a formal permission/waiver was obtained, considering BIDE's IRB approval.




Publication History

Article published online:
30 January 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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