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CC BY 4.0 · Journal of Diabetes and Endocrine Practice 2026; 09(01): 020-028
DOI: 10.1055/s-0045-1813010
Original Article

The 2026 Update of the IDF-DAR Risk Calculator for Fasting in People with Diabetes

Authors

  • Bachar Afandi

    1   Department of Endocrinology, Tawam Hospital, Al Ain, United Arab Emirates
    2   Department of Endocrinology, Sheikh Tahnoon Bin Mohammed Medical City, Al Ain, United Arab Emirates
    3   Department of Medicine, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates

  • Mohamed Suliman

    4   Department of Endocrinology, Tameside General Hospital, Ashton-under-Lyne, Manchester, United Kingdom

  • Shehla Shaikh

    5   Diabetes & Endocrinology Centre, Saifee Hospital, Mumbai, India

  • Salem A. Beshyah 

    6   Department of Medicine, College of Medicine, Dubai Medical University, Dubai, United Arab Emirates
    7   Department of Endocrinology, Bareen International Hospital, MBZ City, Abu Dhabi, United Arab Emirates

  • Mohamed Hasannien 

    8   Department of Medicine, Mohammed Bin Rashid University, Dubai, United Arab Emirates
    9   Department of Endocrinology, Dubai Hospital, Dubai, United Arab Emirates

Funding and Sponsorship None.
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Abstract

Background

Risk stratification is essential for guiding individuals with diabetes during Ramadan. While the 2021 International Diabetes Federation–Diabetes and Ramadan (IDF-DAR) Risk Calculator provided a structured, evidence-based approach, recent multinational surveys and real-world studies have generated new insights into patient characteristics, therapy patterns, and complications associated with fasting. These findings highlighted the need to refine risk assessment to reflect real-world practice and individual vulnerability.

Materials and Methods

The 2026 IDF-DAR Risk Calculator was developed through a multistage, consensus-driven process involving endocrinologists and diabetes specialists. The steering committee reviewed the latest literature, analyzed case scenarios, and incorporated data from the DAR Global Surveys and other regional validation studies. Risk factors—including frailty, pregnancy, multiple microvascular complications, and therapy-related elements—were systematically re-evaluated to enhance predictive accuracy and clinical relevance.

Results

The updated calculator stratifies patients into three categories: low (score 0–3), moderate (score 3.25–6), and high (score > 6). Key modifications include refined hypoglycemia thresholds, the incorporation of advanced diabetes technologies, and the reweighting of patient vulnerability factors. Validation studies across diverse populations confirmed the tool's predictive accuracy while maintaining a cautious approach to ensure safety. The 2026 update aligns medical guidance with religious considerations, supporting individualized, practical, and safe fasting recommendations.

Conclusion

The 2026 IDF-DAR Risk Calculator update offers a refined, evidence-based framework for evaluating fasting risk in individuals with diabetes. By integrating emerging real-world data, updated therapy considerations, and individual vulnerability factors, it strengthens shared decision-making between patients, clinicians, and religious authorities. Future prospective validation and digital integration will further optimize its global applicability.

Keywords

diabetes - Ramadan fasting - risk stratification - IDF-DAR - hypoglycemia - frailty

Authors' Contribution

All authors contributed to the conception, data collection, writing, and final approval of the manuscript.


Statement of Ethics

Ethical approval is not required.


Data Availability Statement

Not applicable.




Publication History

Article published online:
21 November 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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