Validation of the IDF-DAR Risk Assessment Tool for Ramadan Fasting in Diabetic Patients in Primary Care

Latifa Mohammad Baynouna Al Ketbi ^1* Bachar Afandi ^2* Nico Nagelkerke ³ Hanan Abdubaqi ¹ Ruqaya Abdulla Al Nuaimi ¹ Mariam Rashed Al Saedi ¹ Fatima Ibrahim Al Blooshi ¹ Noura Salem Al Blooshi ¹ Aysha Mohammed AlAryani ¹ Nouf Mohammed Al Marzooqi ¹ Amal Abdullah Al Khouri ¹ Shamsa Ahmed Al Mansoori ¹ Mohammad Hassanein ⁴

• ¹ Abu Dhabi Healthcare Services, Ambulatory Healthcare Services., Al Ain, United Arab Emirates
• ² Tawam Hospital, Al Ain, Abu Dhabi, United Arab Emirates
• ³ College of Medicine and Health Sciences, United Arab Emirates University, AlAin, Abu Dhabi, United Arab Emirates
• ⁴ Dubai Hospital, Dubai, United Arab Emirates

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.The assessment was done before Ramadan, followed by an evaluation of any significant outcome after Ramadan through tele-interview and an electronic medical records review. 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.The study included 435 patients. Half (51.7%) were in the low-risk category of the IDF-DAR risk stratification tool, 28.5% in the moderate-risk category, and 19.8% in the higher-risk category. Of the patients who fasted all of Ramadan, 81.3% and 18.7% attempted to fast. Of 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 univariable logistic regression, the occurrence of adverse events was significantly associated with more days not fasted B= -0.126, p<0.001, OR=0.88 (0.839-0.927). Other risk factors identified of the occurrence of adverse events using multivariable logistic regression controlled for all variables studied in this study were; being in the low-risk category of the DAR risk assessment tool B= -1.1, OR= 0.34 (0.157-0.744), p value=0.0072, being in the frail category compared to the reference category, the robust category, B=1.54,) p value=0.018 and older age B= -0.034, OR=0.966 (0.938-0.995). There was no significant difference between moderate and high-risk categories in the occurrence of SAE. Similar determinants were identified of fasting all Ramadan using multivariable logistic regression.According to the IDF-DAR risk assessment, diabetic patients in the low-risk category had a better outcome than those in the Moderate or high-risk categories regarding significant adverse events.Another independent risk factor is if the patient is Frail, according to the FRAIL scoring.