Sodium glucose co transporter 2 inhibitors and Ramadan: Another string to the bow

Diabetes prevalence shows a continuous increasing trend in South Asia. Although well-established treatment modalities exist for type 2 diabetes mellitus (T2DM) management, they are limited by their side effect profile. Sodium–glucose co-transporter 2 inhibitors (SGLT2i) with their novel insulin-independent renal action provide improved glycemic control, supplemented by reduction in weight and blood pressure, and cardiovascular safety. Based on the clinical outcomes with SGLT2i in patients with T2DM, treatment strategies that make a “good clinical sense” are desirable. Considering the peculiar lifestyle, body types, dietary patterns (long duration religious fasts), and the hot climate of the South Asian population, a unanimous decision was taken to design specific, customized guidelines for T2DM treatment strategies in these regions. The panel met for a discussion three times so as to get a consensus for the guidelines, and only unanimous consensus was included. After careful consideration of the quality and strength of the available evidence, the executive summary of this consensus statement was developed based on the American Association of Clinical Endocrinologists/American College of Endocrinology protocol.

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“…However, as these drugs cause fluid loss, precaution has to be exercised to prevent situations of dehydration. [157158]…”

Section: Use In Special Populationsmentioning

confidence: 99%

Safe and pragmatic use of sodium–glucose co-transporter 2 inhibitors in type 2 diabetes mellitus: South Asian Federation of Endocrine Societies consensus statement

Kalra

Ghosh

Aamir

et al. 2017

Indian J Endocr Metab

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“…Persons who abstain from water and other liquids during the hot Indian summer run the risk of dehydration, dyselectrolytemia, and hypotension. [ 4 ] Over-indulgence in high-fat, high-carbohydrate, calorie-rich foods, after completion of the fasting period, may cause peaks of hyperglycemia and worsen glycemia variability. These issues pose a challenge for the diabetes care provider, who is expected to craft an individualized dietary, physical activity and medical prescription, which is able to achieve adequate glycemic control on both fasting and non-fasting days, without either hypo- or-hyper-glycemia.…”

Section: H Indu F Astsmentioning

confidence: 99%

Fasts, feasts and festivals in diabetes-1: Glycemic management during Hindu fasts

Kalra

Bajaj

Gupta

et al. 2015

Indian J Endocr Metab

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This communication is the first of a series on South Asian fasts, festivals, and diabetes, designed to spread awareness and stimulate research on this aspect of diabetes and metabolic care. It describes the various fasts observed as part of Hindu religion and offers a classification scheme for them, labeling them as infrequent and frequent. The infrequent fasts are further sub-classified as brief and prolonged, to facilitate a scientific approach to glycemic management during these fasts. Pre-fast counseling, non-pharmacological therapy, pharmacological modification, and post-fast debriefing are discussed in detail. All available drug classes and molecules are covered in this article, which provides guidance about necessary changes in dosage and timing of administration. While in no way exhaustive, the brief review offers a basic framework which diabetes care professionals can use to counsel and manage persons in their care who wish to observe various Hindu fasts.

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“…The risk of inducing hypoglycemia is low with SGLT-2 inhibitors because of their insulin-independent action and hence forms an attractive class for managing patients with type 2 DM during Ramadan. However, caution is recommended while using these medications because of their ability to cause dehydration, especially in the setting of absence of fluid intake, which occurs during fasting hours of Ramadan [ 42 , 43 ]. Recently FDA added many warning on such class of medication because of their risk to induce ketoacidosis and increase risk of foot and leg amputation, serious urinary tract infections, acute renal failure, and osteoporosis [ 44 ].…”

Section: Resultsmentioning

confidence: 99%

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

Mikhael

2016

Journal of Diabetes Research

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Hypoglycemia is the most common side effects for most glucose-lowering therapies. It constitutes a serious risk that faces diabetic patients who fast during Ramadan (the 9th month in the Islamic calendar). New glucose-lowering classes like dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide 1 receptor agonist (GLP-1 RA), and sodium-glucose cotransporter-2 (SGLT-2) inhibitors are efficacious in controlling blood glucose level with less tendency to induce hypoglycemia and thus may constitute a good choice for diabetic patients during Ramadan. This study reviews the safety and efficacy of newer glucose-lowering therapies during Ramadan. This study was accomplished through a careful literature search about studies that assess the benefit and side effects of these new glucose-lowering therapies during Ramadan during September 2015. Vildagliptin, sitagliptin, liraglutide, exenatide, and dapagliflozin were the only studied glucose-lowering therapies. All of the studied newer glucose-lowering therapies except dapagliflozin were associated with reduced risk to induce hypoglycemia. Gastrointestinal upset was common with the usage of liraglutide while increased thirst sensation was common with dapagliflozin. In conclusion DPP-4 inhibitors such as vildagliptin and sitagliptin may form a suitable glucose-lowering therapy option for Ramadan fasting patients.

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Sodium glucose co transporter 2 inhibitors and Ramadan: Another string to the bow

Cited by 6 publications

References 7 publications

Safe and pragmatic use of sodium–glucose co-transporter 2 inhibitors in type 2 diabetes mellitus: South Asian Federation of Endocrine Societies consensus statement

Safe and pragmatic use of sodium–glucose co-transporter 2 inhibitors in type 2 diabetes mellitus: South Asian Federation of Endocrine Societies consensus statement

Fasts, feasts and festivals in diabetes-1: Glycemic management during Hindu fasts

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

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