TABLE 1

Risk of complications during Ramadan fasting: International Diabetes Federation categories

Category 1: very high risk
One or more of the following:
  • Severe hypoglycemia within the 3 months before Ramadan

  • Diabetic ketoacidosis within the 3 months before

  • Ramadan

  • Hyperosmolar hyperglycemic coma within the 3 months before Ramadan

  • History of recurrent hypoglycemia

  • History of hypoglycemia unawareness

  • Poorly controlled type 1 diabetes

  • Acute illness

  • Pregnancy with preexisting diabetes, or gestational diabetes treated with insulin or a sulfonylurea

  • Chronic dialysis or stage 4 or 5 chronic kidney disease

  • Advanced macrovascular complications

  • Old age with ill health

Category 2: high risk
One or more of the following:
  • Type 2 diabetes with sustained poor glycemic control

  • Well-controlled type 1 diabetes

  • Well-controlled type 2 diabetes on multiple-dose insulin or mixed insulin

  • Pregnancy with type 2 diabetes or gestational diabetes controlled with diet only or with metformin

  • Stage 3 chronic kidney disease

  • Stable macrovascular complications

  • Comorbid conditions that present additional risk factors

  • Diabetes and intense physical activity

  • Treatment with drugs that may affect cognitive function

Category 3: moderate/low risk
Well-controlled type 2 diabetes treated with one or more of the following:
  • Lifestyle therapy

  • Metformin

  • Acarbose

  • Thiazolidinediones

  • Second-generation sulfonylurea

  • Incretin-based therapy

  • Sodium-glucose cotransporter 2 inhibitor

  • Basal insulin