Treatment Options for Patients with Type 2 Diabetes Mellitus during the Fasting Month of Ramadan

Loh, Huai Heng; Kamaruddin, Nor Azmi

doi:10.47102/annals-acadmedsg.202060

Cited by 3 publications

(5 citation statements)

References 55 publications

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“…However, the use of newer second-generation sulfonylureas with a lower risk of hypoglycemia, such as gliclazide MR, has increased during this time [10, 28]. In addition, evidence from randomized clinical trials has shown that gliclazide MR is an effective glucose-lowering agent with a very low risk of severe hypoglycemia and with no differences in the risk of mortality or cardiovascular events compared with other classes of glucose-lowering therapies [8, 28]. Although real-world studies have confirmed these results in clinical practice [28], the DIA-RAMADAN study has recently shown that the benefits of using gliclazide MR can also be extended to T2DM patients who fast during Ramadan [21].…”

Section: Discussionmentioning

confidence: 99%

“…Ramadan fasting is one of the five pillars of Islam. During Ramadan, Muslims fast from sunrise (Sahur) to sunset (Iftar) throughout the ninth lunar month of the Islamic calendar and are required to abstain from food and fluids, including oral and most of injectable drugs [6, 8]. Although patients with some chronic conditions may be exempt from fasting, the majority of patients with T2DM choose to fast [9, 10].…”

Section: Introductionmentioning

confidence: 99%

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A Real-World Study in Patients with Type 2 Diabetes Treated with Gliclazide Modified Release during Fasting in Gulf Cooperation Council Countries: An Analysis from the International DIA-RAMADAN Study

Hassanein

Sifri²,

Awadi

et al. 2022

Dubai Diabetes Endocrinol J

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Introduction: The safety and effectiveness of gliclazide modified release (MR) in patients with type 2 diabetes mellitus (T2DM) who fasted during Ramadan were previously published. Here, we carried out a regional analysis among patients living in Gulf Cooperation Council (GCC) countries. Patients and Methods: DIA-RAMADAN was a real-world, observational, international, noncomparative study conducted in nine countries that included >1200 T2DM adults receiving gliclazide MR for at least 90 days before inclusion. The study comprised 2 visits: at inclusion, 6–8 weeks before the start of Ramadan (V0) and 4–6 weeks after the end of Ramadan (V1). The primary endpoint was the proportion of patients reporting ≥1 symptomatic hypoglycemic event as collected using a patient diary. Changes in HbA1c, fasting plasma glucose (FPG), and weight were also analyzed. This manuscript represents data collected in GCC countries (Kuwait, Saudi Arabia, and United Arab Emirates). Results: Data from 161 patients were analyzed: mean (SD) age 56.8 (10.6) years, 30.4% women, body mass index 29.1 (3.7) kg/m2, T2DM disease duration 6.7 (3.3) years, baseline HbA1c 7.9% (0.8). The proportions of patients reporting ≥1 symptomatic hypoglycemic event or confirmed hypoglycemia during Ramadan were 4.3% and 0.6%, respectively. No cases of severe hypoglycemia were reported. Significant reductions in main variables were observed before the start of Ramadan (V0) and 4–6 weeks after the end of Ramadan (V1): HbA1c (from 7.9 [0.8] to 7.6 [0.7]%; p value <0.001), FPG (from 143.5 [24.3] to 137.9 [25.2] mg/dL; p value = 0.031), and weight (from 79.0 [73.0–86.0] to 78.0 [72.0–85.0] kg; p value = 0.018). Conclusions: These real-world data indicate that patients with T2DM treated with gliclazide MR during Ramadan in the selected GCC countries have a low risk of hypoglycemia and maintain glycemic control and weight while fasting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Real-World Study in Patients with Type 2 Diabetes Treated with Gliclazide Modified Release during Fasting in Gulf Cooperation Council Countries: An Analysis from the International DIA-RAMADAN Study

Hassanein

Sifri²,

Awadi

et al. 2022

Dubai Diabetes Endocrinol J

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“…Recommendations have been written previously for Muslim patients observing the fasting month of Ramadan. 55,56 Studies have shown that the use of SGLT-2 inhibitors during Ramadan is safe with no major adverse effects and may even result in an improvement in HbA1c. 57 In summary, we suggest that the following modifications be made during the month of Ramadan fasting:…”

Section: Euglycaemic Diabetic Ketoacidosismentioning

confidence: 99%

Practical considerations for the use of SGLT‐2 inhibitors in the Asia–Pacific countries—An expert consensus statement

Liew,

Lydia,

Matawaran

et al. 2023

Nephrology

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Recent clinical studies have demonstrated the effectiveness of SGLT‐2 inhibitors in reducing the risks of cardiovascular and renal events in both patients with and without type 2 diabetes mellitus. Consequently, many international guidelines have begun advocating for the use of SGLT‐2 inhibitors for the purpose of organ protection rather than as simply a glucose‐lowering agent. However, despite the consistent clinical benefits and available strong guideline recommendations, the utilization of SGLT‐2 inhibitors have been unexpectedly low in many countries, a trend which is much more noticeable in low resource settings. Unfamiliarity with the recent focus in their organ protective role and clinical indications; concerns with potential adverse effects of SGLT‐2 inhibitors, including acute kidney injury, genitourinary infections, euglycemic ketoacidosis; and their safety profile in elderly populations have been identified as deterring factors to their more widespread use. This review serves as a practical guide to clinicians managing patients who could benefit from SGLT‐2 inhibitors treatment and instill greater confidence in the initiation of these drugs, with the aim of optimizing their utilization rates in high‐risk populations.

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“…Crucially, the role of SGLT-2 inhibitors has been rarely elaborated in a network meta-analysis to show efficacy in fasting diabetic patients. Currently, most studies have shown that hypoglycemia during Ramadan can be curbed by shifting the therapy from insulin or other oral hypoglycemics to DPP-4 inhibitors or metformin [1,5,6]. A network meta-analysis by Lee et al showed that newer antidiabetics exhibit appropriate glycemic control and lower hypoglycemic complications than sulfonylureas [8].…”

Section: Introductionmentioning

confidence: 99%

“…However, maintaining glycemic control may be difficult, especially for diabetic Muslims who fast during the holy month of Ramadan. [4] Therein lies the major and serious complication of hypoglycemia associated with fasting and oral hypoglycemic antidiabetic such as meglitinides and sulfonylureas [1,5,6]. The Epidemiology of Diabetes and Ramadan (EPIDIAR) demonstrated that around 78.5% of Muslim diabetic patients who fast did not refrain from fasting for at least 15 days.…”

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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Treatment Options for Patients with Type 2 Diabetes Mellitus during the Fasting Month of Ramadan

Cited by 3 publications

References 55 publications

A Real-World Study in Patients with Type 2 Diabetes Treated with Gliclazide Modified Release during Fasting in Gulf Cooperation Council Countries: An Analysis from the International DIA-RAMADAN Study

A Real-World Study in Patients with Type 2 Diabetes Treated with Gliclazide Modified Release during Fasting in Gulf Cooperation Council Countries: An Analysis from the International DIA-RAMADAN Study

Practical considerations for the use of SGLT‐2 inhibitors in the Asia–Pacific countries—An expert consensus statement

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

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