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Pre-Ramadan assessment and Risk calculation for people with diabetes who want to fast during Ramadan

Pre-Ramadan assessment in patients with diabetes who want to fast

Pre-assessment should take place 6–8 weeks before Ramadan and should review:

  • Diabetes type and duration
  • Diabetes medication
  • Complications and/or comorbidities
  • Hypoglycaemia risk
  • Previous experience during Ramadan
  • Ability to self-manage diabetes
  • Social and work circumstances

Prior to Ramadan, patients should also receive structured education on:

  • Role of SMBG
  • Fluid intake
  • Meal planning
  • When to exercise
  • Medication adjustments
  • Risk quantification
  • When to break the fast

Risk calculation and suggested risk score for people with diabetes who want to fast during Ramadan

Document
Total score Category
0 to 3 Low risk
3.5 to 6 Moderate risk
>6 High risk
Diabetes type and duration
Score
Type 1 diabetes 1
Type 2 diabetes 0
A duration of ≥10 years 1
A duration of <10 years 0
Acute complications
Score
DKA/HONC in the last 3 months 3
DKA/HONC in the last 6 months 2
DKA/HONC in the last 12 months 1
No DKA or HONC 0
Physical Labour
Score
Highly Intense physical labour 4
Moderate Intense Physical Labour 2
No physical labour 0
Fasting hours (location)
Score
≥16 hours 1
<16 hours 0
Presence of hypoglycaemia
Score
Hypoglycaemia unawareness 6.5
Recent Severe hypoglycaemia 5.5
Multiple weekly Hypoglycaemia 3.5
Hypoglycaemia less than 1 time per week 1
No hypoglycaemia 0
MVD Complications/Comorbidities
Score
Unstable MVD 6.5
Stable MVD 2
No MVD 0
Renal Complications/Comorbidities
Score
eGFR < 30 mL/min 6.5
eGFR 30–45 mL/min 4
eGFR 45–60 mL/min 2
eGFR >60 mL/min 0
Self-Monitoring of Blood Glucose (SMBG)
Score
Indicated but not conducted 2
Indicated but conducted sub-optimally 1
Conducted as indicated 0
Level of glycaemic control
Score
HbA1c >9% (11.7 mmol/L) 2
HbA1c 7.5–9% (9.4–11.7 mmol/L) 1
HbA1c <7.5% (9.4 mmol/L) 0
Pregnancy*
Score
Pregnant not within targets* 6.5
Pregnant within targets* 3.5
Not pregnant 0
Frailty and Cognitive function
Score
Impaired cognitive function or Frail 6.5
> 70 years old with no home support 3.5
No frailty or loss in cognitive function 0
Previous Ramadan Experience
Score
Overall negative experience 1
No negative or positive experience 0
Type of treatment
Score
Multiple daily mixed insulin injections 3
Basal Bolus/Insulin pump 2.5
Once-daily mixed insulin 2
Basal insulin 1.5
Glibenclamide 1
Gliclazide/MR or glimepride or repeglanide 0.5
Other therapy not including SU or insulin 0

DKA — Diabetic Ketoacidosis
HONC — Hyperglycaemic Hyperosmolar Nonketotic Coma
eGFR — Estimated glomerular filtration rate
MVD — Macrovascular disease

*Pregnant and breastfeeding women have the right to not fast regardless of whether they have diabetes

Total score Category
0 Low risk
Reset

CVD, cardiovascular disease; DKA, diabetic ketoacidosis; eGFR, estimated glomerular filtration rate; HONC, hyperglycaemic hyperosmolar non-ketotic coma; MR, modified release; SMBG, self-monitored blood glucose; SU, sulphonylurea

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MAT-BH-2500078/v1/Feb2025