Risk Assessment Among Diabetic Patients for Ramadan Fasting: A Multi-Center Study in Bangladesh

Open Access

Abstract

Introduction: Ramadan fasting is observed by millions of Muslims worldwide and presents unique metabolic challenges for patients with diabetes mellitus. Altered meal timing, prolonged fasting hours, and medication adjustments may predispose individuals to complications such as hypoglycemia, hyperglycemia, dehydration, and diabetic ketoacidosis. Despite medical exemptions, many diabetic patients choose to fast during Ramadan. Therefore, structured pre-Ramadan risk assessment using standardized tools such as the International Diabetes Federation Diabetes and Ramadan (IDF–DAR 2026) risk score is essential to ensure safe fasting practices. Aim of the Study: To evaluate the fasting risk profile of diabetic patients using the IDF–DAR 2026 risk scoring system and to assess the effect of structured pre-Ramadan interventions on risk stratification. Methods & Materials: This multi-center hospital-based cross-sectional observational study was conducted among diabetic patients attending private outpatient chambers and outpatient departments of four government hospitals in Bangladesh. The hospital sites included Dhaka North City Corporation Hospital, Sathkhira Medical College, Narayanganj General Hospital and Chandpur General Hospital. Included 100 diabetic patients assessed before Ramadan. Risk stratification was performed using the IDF–DAR 2026 risk score, which evaluates multiple components, including type and duration of diabetes, treatment regimen, glycemic control, history of hypoglycemia, presence of complications, and lifestyle factors. Following the baseline risk assessment, structured pre-Ramadan interventions were implemented, including diabetes education, medication optimization, lifestyle counseling, and glucose monitoring guidance. Risk scores were reassessed after the intervention to evaluate changes in risk distribution. Results: Among the 100 participants, 72% were female and 98% had type 2 diabetes mellitus. The majority of patients (62%) had diabetes for 10–20 years. Suboptimal glycemic control was common, with 84% having HbA1c ≥7.5%. Before intervention, 42% of patients were categorized as high risk, 50% as moderate risk, and only 8% as low risk according to the IDF–DAR score 2026. Following a structured Ramadan intervention, the proportion of high-risk patients decreased to 20%, whereas the proportion of low-risk patients increased to 22%. The most common interventions included fasting-focused diabetes education (68%), medication adjustment (42%), insulin regimen optimization (30%), lifestyle modification (24%), and glucose monitoring promotion (24%). Conclusion: A substantial proportion of diabetic patients intending to fast during Ramadan fall into moderate-to-high risk categories. Structured Pre-Ramadan assessment and targeted interventions significantly improve risk stratification and may enhance fasting safety.