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

Abstract

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.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.The updated calculator stratifies patients into three categories: low (score 0–3), moderate (score 3.5–6), 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.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.