Effectiveness and Safety of Newer Antidiabetic Medications for Ramadan Fasting Diabetic Patients

Mikhael, Ehab Mudher

doi:10.1155/2016/6962574

Cited by 9 publications

(7 citation statements)

References 37 publications

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“…There is scarce data on the rate of hypoglycaemia in non-insulin-treated patients with type 2 diabetes during Ramadan fasting. However, recent studies have shown that the newer anti-diabetic medications – DPP-4 inhibitors, GLP-1 agonists, and SGLT2 inhibitors – are safe during Ramadan fasting and have lower risk for hypoglycaemia compared to SU [12,14,18,19]. Pre-Ramadan individualized advice and education provided at our centre may have played a role in preventing significant increase in the rate of hypoglycaemia [20,21].…”

Section: Discussionmentioning

confidence: 99%

Initial increase in glucose variability during Ramadan fasting in non-insulin-treated patients with diabetes type 2 using continuous glucose monitoring

Aldawi

Darwiche

Abusnana

et al. 2018

Libyan Journal of Medicine

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There are no studies evaluating the glucose variability in different periods of Ramadan fasting in patients with type 2 diabetes using continuous glucose monitoring (CGM). This study examined the effect of Ramadan fasting on interstitial glucose (IG) variability in early,- late-, and post-Ramadan compared to pre-Ramadan days in non-insulin-treated type 2 diabetes patients. Participants had a CGM system connected 2 or 3 days before Ramadan start, which was removed on the third or fourth day of Ramadan. CGM performance continued for a total of 6 days. A second CGM performance started on the 27th or 28th day of Ramadan and ended on the 4th or 5th post-Ramadan day. First, CGM recordings were divided into pre-Ramadan and early-Ramadan CGM, and second recordings into late-Ramadan and post-Ramadan. At each visit, blood pressure, body weight, and waist circumference were measured, and fasting blood samples were collected for HbA1c and plasma glucose. All patients received recommended Ramadan education before Ramadan. Thirty-three patients (mean age 55.0 ± 9.8 years, 73% males) were prospectively included. IG variability, estimated as mean amplitude of glycaemic excursions (MAGE), increased significantly in early-Ramadan compared to pre-Ramadan (P = 0.006) but not in late-Ramadan and post-Ramadan recording days. Only patients on >2 anti-diabetic drugs (n = 16, P = 0.019) and those on sulphonylureas (n = 14, P = 0.003) showed significant increase in MAGE in early-Ramadan. No significant changes were seen in coefficient of variation, time in range, time in hyperglycaemia, or time in hypoglycaemia. Except for an initial increase in glucose variability, fasting Ramadan for patients with non-insulin-treated type 2 diabetes did not cause any significant changes in glucose variability or time in hypoglycaemia during CGM recording days compared to non-fasting pre-Ramadan period.

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Section: Discussionmentioning

confidence: 99%

Initial increase in glucose variability during Ramadan fasting in non-insulin-treated patients with diabetes type 2 using continuous glucose monitoring

Aldawi

Darwiche

Abusnana

et al. 2018

Libyan Journal of Medicine

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“…This can be caution in fasting, because of extreme temperatures in Pakistan, especially in summers. 3 In previous literature, EPIDIAR study 4 showed that there was a 7.5% increased risk of hypoglycemia in patients who wanted to fast. It showed the importance of hypoglycemia as the single most important complication of fasting diabetics.…”

Section: Introductionmentioning

confidence: 97%

Sodium-Glucose Cotransporter 2 (SGLT-2) Inhibitor drugs: Assessment of safety in Fasting Diabetics

Khan¹,

Shakeel²,

Azhar³

et al. 2021

JRMC

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Introduction: Ramadan is a holy month and the majority of Muslims fast in it, without considering background illnesses. SGLT-2 drugs were available for Pakistani patients recently, and this was the first year to fast in their presence.Objectives: To assess the risk of hypoglycemia in fasting diabetics using SGLT-2 drugs, comparing it with Sulphonylurea (SU) drugs. Also, a change in HbA1c and eGFR was checked. Hence, evidence was collected to recommend their use in fasting Diabetics with safety. Material and Methods: A total of 5500 patients from three different sites were included. Only 500 fulfilled the criteria of inclusion. Pregnant, lactating, advanced Chronic Kidney Disease (CKD), and those recording hypoglycemia frequently were not included. Ages between 20 to 70 years, HbA1c between 7 to 11, and patients taking SU or SGLT-2 were included. Conclusion: The eGFR was comparable in both groups post-Ramadan. HbA1c was significantly reduced in the SGLT-2 group. Bitter taste and thirst were common with the SU group. Hypoglycemia was comparable in both groups. We concluded that SGLT-2 drugs were safe during Ramadan, and caused more HbA1c reduction.

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“…Fasting is one of the basic principles of Islam, a religion that over a billion people practice. Healthy Muslim adults must cease eating and drinking from sunrise to sunset during Ramadan, the 9 th lunar month in the Islamic calendar [1,2]. Presently, there are more than 150 million Muslim diabetics globally [3], and the number of diabetics worldwide is expected to surpass 360 million by 2030 [2].…”

Section: Introductionmentioning

confidence: 99%

Hypoglycemic Events in Diabetic Patients under Non-insulin Regimens During Ramadan: A Frequentist Network Meta-Analysis

Kacimi

Sukaina

Elgenidy

et al. 2022

Preprint

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Background: Diabetic Muslims who choose to fast during Ramadan encounter major risks such as hyperglycemia, hypoglycemia, diabetic ketoacidosis, and dehydration. Recently, newer antidiabetic agents have been found to be less likely to cause hypoglycemic emergencies. This meta-analysis aimed to present collective and conclusive results from major randomized controlled trials (RCTs) to determine the risk of hypoglycemia among patients taking oral antidiabetics during Ramadan. Methods: We searched PubMed, Web of Science, and Google Scholar for RCTs. We performed a frequentist network meta-analysis using the (netmeta) package of R software version 4.1.1 to investigate the risk of developing hypoglycemia after taking oral antidiabetic drugs during Ramadan. Results: Nine RCTs with a total of 3464 patients were included in the final analysis. In the comparison of all antidiabetic drug classes with sulfonylureas, SGLT-2 inhibitors were associated with the lowest hypoglycemic risk (RR, 0.18; 95% CI, 0.04-0.78; P-score, 0.909), followed by GLP-1 agonists (RR, 0.31; 95% CI, 0.17-0.56; P-score, 0.799), and DDP-4 inhibitors (RR, 0.57; 95% CI, 0.43-0.75; P-score, 0.483). When comparing individual drugs, dapagliflozin was associated with the lowest hypoglycemic risk (RR, 0.18; 95% CI, 0.04-0.78; P-score, 0.874), followed by lixisenatide (RR, 0.25; 95% CI, 0.09-0.71; P-score, 0.813), liraglutide (RR, 0.34; 95% CI, 0.17-0.69; P-score, 0.715), and sitagliptin (RR. 0.51; 95% CI, 0.37-0.71; P-score, 0.515). Conclusion : SGLT-2 inhibitors are associated with the least documented hypoglycemic events and adverse outcomes compared with other oral hypoglycemic drugs. These findings could have considerable public health and clinical implications when extrapolated to the global Muslim population with a similar clinical background.

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Effectiveness and Safety of Newer Antidiabetic Medications for Ramadan Fasting Diabetic Patients

Cited by 9 publications

References 37 publications

Initial increase in glucose variability during Ramadan fasting in non-insulin-treated patients with diabetes type 2 using continuous glucose monitoring

Initial increase in glucose variability during Ramadan fasting in non-insulin-treated patients with diabetes type 2 using continuous glucose monitoring

Sodium-Glucose Cotransporter 2 (SGLT-2) Inhibitor drugs: Assessment of safety in Fasting Diabetics

Hypoglycemic Events in Diabetic Patients under Non-insulin Regimens During Ramadan: A Frequentist Network Meta-Analysis

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