Meta-analysis on the validity and clinical utility of the IDF/DAR risk stratification tool

To evaluate the predictive performance of the IDF-DAR Risk Calculator in identifying individuals with diabetes at risk of fasting-related complications during Ramadan and to assess preventive interventions based on risk stratification, a systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Cochrane Library, Google Scholar, and Web of Science were searched up to March 2025. Eligible studies assessed adults with diabetes using the calculator before Ramadan and reported fasting-related complications. Five studies met the inclusion criteria, encompassing various geographic and care settings. The meta-analysis demonstrated that high-risk patients had significantly increased odds of hypoglycemia (OR = 6.49, 95 % CI: 1.88-22.46) and hyperglycemia (OR = 5.36, 95 % CI: 2.30-12.57) compared to low-risk patients. Moderate-risk individuals also had increased odds of hypoglycemia (OR = 3.63, 95 % CI: 2.20-5.98) and hyperglycemia (OR = 5.00, 95 % CI: 1.75-14.32). However, differences between high- and moderate-risk groups were not statistically significant. Despite heterogeneity, consistent effects across studies support predictive validity. In conclusion, the IDF-DAR Risk Calculator stratifies risk of glycemic complications during Ramadan, distinguishing high- and moderate-risk patients from those at low risk. Current evidence supports its practical utility for individualized pre-Ramadan assessment and preventive care, though further validation is warranted.