Ramadan fasting intentions and IDF-DAR risk stratification among Nigerian patients with diabetes mellitus: A multicentre, cross-sectional study

Abstract

Diabetes mellitus (DM) is a major public health problem in Nigeria, which has one of the largest Muslim populations in sub-Saharan Africa. Many Muslims with DM choose to fast during Ramadan despite medical exemptions. The International Diabetes Federation-Diabetes and Ramadan Alliance (IDF-DAR) risk stratification tool was developed to guide safe fasting, but has not been previously applied in Nigeria. To apply the IDF-DAR 2021 risk calculator to evaluate fasting intentions and classify risk levels among Nigerian Muslims with diabetes. In this cross-sectional study, 532 Muslim patients with type 1 or type 2 DM were recruited from seven tertiary hospitals in Northern and Southwestern Nigeria, 2–4 weeks before and during the first week of Ramadan in 2024 and 2025. After exclusions, 518 were analyzed. Sociodemographic and clinical data were collected, participants were risk-stratified using the IDF-DAR tool, and fasting intention was recorded. Data were analyzed with descriptive statistics and chi-square tests. Participants' mean age was 57.9 ± 13.0 years; 61.2% were female. Most had type 2 DM (96.3%), with 51.0% having disease duration >10 years. By IDF-DAR classification, 31.7% were low risk, 31.9% moderate risk, and 36.5% high risk. Despite this, 404 participants (78.0%) intended to fast. Among high-risk individuals, 74.6% planned to fast, though risk category was not significantly associated with intention ( p = 0.177). The study demonstrates the feasibility of applying the IDF-DAR tool in Nigeria, with many high-risk patients intending to fast, though predictive accuracy and clinical outcomes were not assessed.