Consultant Family Physician, Diabetologist, Clinical Educator in Department of Medicine, RCSI Medical University of Bahrain, The Kingdom of Bahrain.
Consultant Family Physician, Diabetologist, Primary Health Care, The Kingdom of Bahrain.
Diabetes Res Clin Pract. 2024 May;211:111661. doi: 10.1016/j.diabres.2024.111661. Epub 2024 Apr 10.
There is a high prevalence of diabetes mellitus among Muslim adult patients. Those Muslims are required to fast the holy month of Ramadan. However, the Islam religion exempted some people with medical issues. It was not clear if all the patients with diabetes were considered medically unfit to fast Ramadan. Therefore, IDF-DAR group created a new risk calculator to categorize the patients with diabetes to advise with or against fasting accordingly.
This study is validating the IDF-DAR tool in assessing the accuracy of IDF-DAR risk calculator tool on adult patients with diabetes visiting primary health care in the Kingdom of Bahrain. The study will facilitate the health care professionals' decision to exempt the patients from fasting.
It is a prospective, randomized study for Ramadan 1444/2023 to assess the new IDF-DAR risk score tool that predicts the complications and the negative outcome of fasting during Ramadan. It included pre- and post-Ramadan questionnaires. 757 patients were selected randomly from the patients list of the central diabetes clinics in primary health care for pre-Ramadan risk assessment scoring. Post-Ramadan a phone a questionnaire was done to evaluate the ability of fasting and the occurrence of adverse events.
Out of the 757 participants, 611 were included in the study. The mean age of the studied population was 59.8 years and 52.8 % of them were female. 630 (95.3 %) had type 2 diabetes. According to the new IDF-DAR risk calculator, 184 (27.8 %) were categorized as low risk (≤3 score), 252 (38.1 %) as moderate risk (3-6 score), and 225 (34 %) as high risk (>6 score). The percentage of patients completed their 30 days fasting successfully without reporting adverse events in the low, moderate, and high-risk groups were 92.4 %, 89.3 %, 74.7 % respectively. There was significant increased risk in breaking the fast between the low-risk group and high-risk group with a p-value of <0.001. Similarly, there was significant increased risk in breaking the fast between the moderate-risk group and high-risk group with p-value of <0.001. The main reason of breaking the fast was hypoglycemic attacks. The leading factors that play a significant role in increasing the risk of adverse events during fasting Ramadan were type 1 diabetes mellitus, the presence of previous hypoglycemia attacks, the presence of renal impairment, and negative previous Ramadan experience.
The new IDF-DAR risk calculator is a good tool to predict both the ability to fast Ramadan and the probability of experiencing adverse events (mainly hypoglycemia) in people with diabetes mellitus in Kingdom of Bahrain.
穆斯林成年患者中糖尿病的患病率很高。这些穆斯林被要求在斋月禁食。然而，伊斯兰教豁免了一些有医疗问题的人。目前尚不清楚所有糖尿病患者是否被认为不适宜在斋月禁食。因此，IDF-DAR 小组创建了一个新的风险计算器，对糖尿病患者进行分类，以便据此建议或反对禁食。
本研究旨在验证 IDF-DAR 工具在评估巴林王国初级保健机构就诊的成年糖尿病患者使用 IDF-DAR 风险计算器的准确性。该研究将有助于医疗保健专业人员决定豁免患者禁食。
这是一项针对 1444/2023 年斋月的前瞻性、随机研究，旨在评估新的 IDF-DAR 风险评分工具，该工具可预测糖尿病患者在斋月期间禁食的并发症和不良后果。它包括斋月前和斋月后的问卷调查。从初级保健中心的中央糖尿病诊所的患者名单中随机选择 757 名患者进行斋月前风险评估评分。斋月后，通过电话问卷评估禁食能力和不良事件的发生情况。
在 757 名参与者中，有 611 名被纳入研究。研究人群的平均年龄为 59.8 岁，其中 52.8%为女性。630 名（95.3%）患有 2 型糖尿病。根据新的 IDF-DAR 风险计算器，184 名（27.8%）被归类为低风险（≤3 分），252 名（38.1%）为中风险（3-6 分），225 名（34%）为高风险（>6 分）。在低、中、高风险组中，成功完成 30 天禁食且无不良事件报告的患者比例分别为 92.4%、89.3%和 74.7%。低风险组和高风险组之间的禁食中断风险显著增加，p 值<0.001。同样，中风险组和高风险组之间的禁食中断风险也显著增加，p 值<0.001。禁食中断的主要原因是低血糖发作。在斋月期间发生不良事件（主要是低血糖）的风险增加的主要因素是 1 型糖尿病、既往低血糖发作、肾功能损害和负面的既往斋月经历。
新的 IDF-DAR 风险计算器是一种很好的工具，可以预测巴林王国糖尿病患者在斋月期间禁食的能力和发生不良事件（主要是低血糖）的概率。
