Risk stratification of persons on premixed insulin in Ramadan

Area of Science:

• Endocrinology
• Metabolic Diseases
• Public Health

Background:

• The International Diabetes Federation (IDF) and Diabetes and Ramadan (DAR) Alliance released guidelines for managing diabetes during Ramadan.
• These guidelines categorize individuals fasting during Ramadan into risk groups.
• A key point of contention is the high-risk categorization for all premixed insulin users.

Purpose of the Study:

• To evaluate the risk stratification for premixed insulin users during Ramadan fasting.
• To present evidence from randomized controlled trials regarding premixed insulin safety.
• To discuss the appropriate placement of premixed insulin within the IDF's risk framework.

Main Methods:

• Review of existing randomized controlled trials (RCTs) on premixed insulin use during Ramadan.
• Analysis of data concerning the safety and efficacy of premixed insulin in fasting individuals.
• Comparative assessment of premixed insulin risk against other diabetes management strategies.

Main Results:

• Evidence from RCTs suggests that premixed insulin may not warrant a universal high-risk categorization.
• Data indicates that certain patient profiles using premixed insulin can fast safely.
• The current risk stratification may overestimate the danger for some premixed insulin users.

Conclusions:

• The risk stratification for premixed insulin users in the IDF guidelines requires re-evaluation.
• Personalized risk assessment is crucial for individuals with diabetes who wish to fast during Ramadan.
• Further research and guideline refinement are needed to accurately reflect premixed insulin's role in Ramadan fasting management.