Clarifying the Borderline Risk Threshold in the 2026 IDF-DAR Risk Calculator for Ramadan Fasting in People with Diabetes

Letter to: The 2026 Update of the IDF-DAR Risk Calculator for Fasting in People with Diabetes Journal of Diabetes and Endocrine Practice 2026; 09(01): 020-028 DOI: 10.1055/s-0045-1813010 The 2026 Update of the IDF-DAR Risk Calculator for Fasting in People with Diabetes We read with great interest the article by Afandi et al, “The 2026 Update of the International Diabetes Federation-Diabetes and Ramadan (IDF-DAR) Risk Calculator for Fasting in People with Diabetes.” The updated calculator is a timely and practical framework for individualized pre-Ramadan assessment, particularly because it incorporates emerging real-world data, newer treatment options, and patient vulnerability factors.[ 1 ] We would like to draw attention to a potentially important threshold discrepancy in the reported three-tier risk classification. In the online HTML version, the Results section states that patients are stratified as low risk for scores 0 to 3, moderate risk for scores of 3.25 to 6, and high risk for scores greater than 6. In contrast, the PDF abstract states that the moderate-risk category is 3.5 to 6, and the integrated medical and religious recommendations similarly describe moderate risk as scores between 3.5 and 6 points.[ 1 ] [ 2 ] Although this difference appears small, it has practical implications. A score of 3.25 may occur when quarter-point components are summed. Classifying such a score as low rather than moderate risk could affect pre-Ramadan counseling, shared decision-making, and the reporting of clinical or validation studies using the 2026 calculator. We respectfully suggest that the authors or the journal clarify the intended lower threshold for the moderate-risk category, especially for scores between 3 and 3.5. A brief clarification or corrigendum would support consistent implementation of the 2026 IDF-DAR calculator in clinical practice and research. Declaration of GenAI Use During the writing process of this letter, ChatGPT (OpenAI) was used for language editing and formatting assistance. The author reviewed and edited the text and takes full responsibility for the content of the paper. Authors' Contributions A.O.P. conceptualized the letter, reviewed the published article versions, drafted the manuscript, critically revised the text for important intellectual content, and approved the final version for submission. Publication History Article published online: 20 July 2026 © 2026. 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/) Thieme Medical and Scientific Publishers Private Limited A-13A, Graphix Tower 1, 6th floor, Sector 62, Noida 201309, Uttar Pradesh, India Letter to this article: Reply to the Comment: Clarifying the Borderline Risk Threshold in the 2026 IDF-DAR Risk Calculator for Ramadan Fasting in People with Diabetes Journal of Diabetes and Endocrine Practice eFirst DOI: 10.1055/s-0046-1825827