Objectives: To get a clinical snapshot of the diabetic patients who planned to fast during the month of Ramadan and to determine the ability of the RRR application to effectively risk-stratify patients.

Study Design: Observational study.

Place and Duration of Study: Department of Diabetes & Endocrinology, Armed Forces Hospital Al-Hada, Taif, Kingdom of Saudi Arabia from 1^st April 2018 to 31^st May 2018.

Methodology: Ninety six patients over 15 years of age with diabetes mellitus were risk stratified using standardized risk criteria were enrolled. Detailed analysis of the information was performed to paint a clinical landscape of the patients who intended to fast.

Results: Seventy four percent of the patients were type 2 diabetics, 11% GDM, 31% were between 60-70 years and 17 % had diabetes for more than 20 years. 17% of participants had serious complications during the last three months before Ramadan including hypoglycemia, Diabetic Ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). 59% had chronic diabetic complications. 28 % of patients were on both insulin and oral hypoglycemic agents (OHA) together and 16 % on high risk medications. 25% of patients had an HbA1C of more than 10%. Pertaining to the previous Ramadan experience 19% disclosed having serious complications in the past. 6 % were categorized as low risk individuals, 76% as moderate, 6% high and 12 % as very high risk.

Conclusions: Astonishingly all the patients advised to refrain from fasting insisted on fasting. Considering the latest IDF numbers the above calculated percentages would translate into very huge numbers who are in serious jeopardy. In order to prevent serious consequences it is highly recommends that evidence based and validated risk stratification strategies are implemented in routine clinical practices.

Keywords: Diabetes mellitus, Fast, Hypoglycemia, High risk patients