Table 2.

Risk stratification for people with Diabetes wishing to fast during Ramadan in the background of COVID -19 Pandemic[21,22,23]

Category	Situation
Very High	Poorly controlled patients (HbA1c >8.5%) (Average blood glucose >300 mg/dL)
Risk	Type 1 Diabetes mellitus
	History of Hypoglycemic unawareness, severe or recurrent hypoglycemia, Diabetic ketoacidosis or hyperosmolar hyperglycemic coma in the last 3 months
	Acute illness
	Pre- existing DM in pregnancy or Gestational DM on insulin
	Immunocompromised patients [HIV, Cancer, PTB, Transplant recipients, on immunosuppressants]
	Associated co-morbidities like heart failure, recent myocardial infarction, hepatic failure, severe respiratory illness, CKD Stage 4 and 5]
	Elderly who are ill
	COVID-19 positive patients, or with history of contact or travel with COVID-19 positive patients.
High risk	Moderately controlled patients (HbA1c 7.5-8.5%) (Average blood glucose 150-300 mg/dL)
	Renal insufficiency- CKD stage 3
	Pregnant and lactating women- controlled by diet only or metformin
	Living alone on multiple insulin injections
	Autonomic neuropathy, moderate to severe micro and microvascular complications
	Members living in same premises of COVID-19 positive patient
Moderate risk	Patients with good glycemic control (HbA1c 7-7.5%)
	On insulin, oral anti-diabetes agents, GLP-1 receptor agonists
	People living in COVID-19 hotspot areas
Low risk	Well controlled patients (HbA1c <7%)
	On lifestyle modification only or monotherapy and healthy

GLP-1: Glucagon-Like-Peptide, CKD: Chronic kidney disease, DM : Diabetes mellitus, HIV : Human Immunodeficiency virus, PTB : Pulmonary tuberculosis. Adapted from: ADA 2020, IDF 2016, IGDR 2015, IDF-DAR Practical Guidelines, South Asian Consensus Guidelines, ICMR guidelines, South Asian Health Foundation Update