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Nakhleh A, Mazareeb J, Darawshi S, Masri A, Shehadeh N. Safety and Effectiveness of Sodium-Glucose Co-transporter 2 Inhibitors on Glycemic Control in Patients with Type 2 Diabetes Mellitus Fasting during Ramadan: A Review. Clin Med Insights Endocrinol Diabetes 2024; 17:11795514241238058. [PMID: 38495948 PMCID: PMC10943741 DOI: 10.1177/11795514241238058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/13/2024] [Indexed: 03/19/2024] Open
Abstract
This review evaluates the current evidence on the safety and efficacy of sodium-glucose cotransporter 2 (SGLT2) inhibitors for patients with type 2 diabetes mellitus (T2DM) fasting during Ramadan. All studies included in the review were conducted in Asia and the Middle East. Overall, the evidence suggests that SGLT2 inhibitors are a safe and effective treatment option for most T2DM patients fasting during Ramadan. The average incidence of symptomatic hypoglycemia is 12.5%, but ranges from 0.7% to 27%, depending on the study population and concomitant use of other medications. The risk of hypoglycemia is increased when SGLT2 inhibitors are used in combination with insulin and/or sulfonylureas. Therefore, patients taking SGLT2 inhibitors in combination with insulin and/or sulfonylureas can take steps to mitigate this risk, such as having their insulin and/or sulfonylurea doses adjusted and being closely monitored for hypoglycemia. Patients taking SGLT2 inhibitors may be at increased risk of dehydration. To mitigate the risk of dehydration, patients should be advised to consume adequate fluids during the fast-breaking hours. Further research is warranted to validate these findings and extend their applicability to high-risk populations and other regions of the world.
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Affiliation(s)
- Afif Nakhleh
- Diabetes and Endocrinology Clinic, Maccabi Healthcare Services, Haifa, Israel
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Jomana Mazareeb
- Diabetes and Endocrinology Clinic, Maccabi Healthcare Services, Haifa, Israel
| | - Said Darawshi
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel
| | - Amin Masri
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel
| | - Naim Shehadeh
- Diabetes and Endocrinology Clinic, Maccabi Healthcare Services, Haifa, Israel
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Lee SWH, Chen WS, Sellappans R, Md Sharif SB, Metzendorf MI, Lai NM. Interventions for people with type 2 diabetes mellitus fasting during Ramadan. Cochrane Database Syst Rev 2023; 7:CD013178. [PMID: 37435938 PMCID: PMC10355254 DOI: 10.1002/14651858.cd013178.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
BACKGROUND Fasting during Ramadan is obligatory for adult Muslims, except those who have a medical illness. Many Muslims with type 2 diabetes (T2DM) choose to fast, which may increase their risks of hypoglycaemia and dehydration. OBJECTIVES To assess the effects of interventions for people with type 2 diabetes fasting during Ramadan. SEARCH METHODS We searched CENTRAL, MEDLINE, PsycINFO, CINAHL, WHO ICTRP and ClinicalTrials.gov (29 June 2022) without language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) conducted during Ramadan that evaluated all pharmacological or behavioural interventions in Muslims with T2DM. DATA COLLECTION AND ANALYSIS Two authors screened and selected records, assessed risk of bias and extracted data independently. Discrepancies were resolved by a third author. For meta-analyses we used a random-effects model, with risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes with their associated 95% confidence intervals (CIs). We assessed the certainty of evidence using the GRADE approach. MAIN RESULTS We included 17 RCTs with 5359 participants, with a four-week study duration and at least four weeks of follow-up. All studies had at least one high-risk domain in the risk of bias assessment. Four trials compared dipeptidyl-peptidase-4 (DPP-4) inhibitors with sulphonylurea. DPP-4 inhibitors may reduce hypoglycaemia compared to sulphonylureas (85/1237 versus 165/1258, RR 0.53, 95% CI 0.41 to 0.68; low-certainty evidence). Serious hypoglycaemia was similar between groups (no events were reported in two trials; 6/279 in the DPP-4 versus 4/278 in the sulphonylurea group was reported in one trial, RR 1.49, 95% CI 0.43 to 5.24; very low-certainty evidence). The evidence was very uncertain about the effects of DPP-4 inhibitors on adverse events other than hypoglycaemia (141/1207 versus 157/1219, RR 0.90, 95% CI 0.52 to 1.54) and HbA1c changes (MD -0.11%, 95% CI -0.57 to 0.36) (very low-certainty evidence for both outcomes). No deaths were reported (moderate-certainty evidence). Health-related quality of life (HRQoL) and treatment satisfaction were not evaluated. Two trials compared meglitinides with sulphonylurea. The evidence is very uncertain about the effect on hypoglycaemia (14/133 versus 21/140, RR 0.72, 95% CI 0.40 to 1.28) and HbA1c changes (MD 0.38%, 95% CI 0.35% to 0.41%) (very low-certainty evidence for both outcomes). Death, serious hypoglycaemic events, adverse events, treatment satisfaction and HRQoL were not evaluated. One trial compared sodium-glucose co-transporter-2 (SGLT-2) inhibitors with sulphonylurea. SGLT-2 may reduce hypoglycaemia compared to sulphonylurea (4/58 versus 13/52, RR 0.28, 95% CI 0.10 to 0.79; low-certainty evidence). The evidence was very uncertain for serious hypoglycaemia (one event reported in both groups, RR 0.90, 95% CI 0.06 to 13.97) and adverse events other than hypoglycaemia (20/58 versus 18/52, RR 1.00, 95% CI 0.60 to 1.67) (very low-certainty evidence for both outcomes). SGLT-2 inhibitors result in little or no difference in HbA1c (MD 0.27%, 95% CI -0.04 to 0.58; 1 trial, 110 participants; low-certainty evidence). Death, treatment satisfaction and HRQoL were not evaluated. Three trials compared glucagon-like peptide 1 (GLP-1) analogues with sulphonylurea. GLP-1 analogues may reduce hypoglycaemia compared to sulphonylurea (20/291 versus 48/305, RR 0.45, 95% CI 0.28 to 0.74; low-certainty evidence). The evidence was very uncertain for serious hypoglycaemia (0/91 versus 1/91, RR 0.33, 95% CI 0.01 to 7.99; very low-certainty evidence). The evidence suggests that GLP-1 analogues result in little to no difference in adverse events other than hypoglycaemia (78/244 versus 55/255, RR 1.50, 95% CI 0.86 to 2.61; very low-certainty evidence), treatment satisfaction (MD -0.18, 95% CI -3.18 to 2.82; very low-certainty evidence) or change in HbA1c (MD -0.04%, 95% CI -0.45% to 0.36%; 2 trials, 246 participants; low-certainty evidence). Death and HRQoL were not evaluated. Two trials compared insulin analogues with biphasic insulin. The evidence was very uncertain about the effects of insulin analogues on hypoglycaemia (47/256 versus 81/244, RR 0.43, 95% CI 0.13 to 1.40) and serious hypoglycaemia (4/131 versus 3/132, RR 1.34, 95% CI 0.31 to 5.89) (very low-certainty evidence for both outcomes). The evidence was very uncertain for the effect of insulin analogues on adverse effects other than hypoglycaemia (109/256 versus 114/244, RR 0.83, 95% CI 0.44 to 1.56; very low-certainty evidence), all-cause mortality (1/131 versus 0/132, RR 3.02, 95% CI 0.12 to 73.53; very low-certainty evidence) and HbA1c changes (MD 0.03%, 95% CI -0.17% to 0.23%; 1 trial, 245 participants; very low-certainty evidence). Treatment satisfaction and HRQoL were not evaluated. Two trials compared telemedicine with usual care. The evidence was very uncertain about the effect of telemedicine on hypoglycaemia compared with usual care (9/63 versus 23/58, RR 0.42, 95% CI 0.24 to 0.74; very low-certainty evidence), HRQoL (MD 0.06, 95% CI -0.03 to 0.15; very low-certainty evidence) and HbA1c change (MD -0.84%, 95% CI -1.51% to -0.17%; very low-certainty evidence). Death, serious hypoglycaemia, AEs other than hypoglycaemia and treatment satisfaction were not evaluated. Two trials compared Ramadan-focused patient education with usual care. The evidence was very uncertain about the effect of Ramadan-focused patient education on hypoglycaemia (49/213 versus 42/209, RR 1.17, 95% CI 0.82 to 1.66; very low-certainty evidence) and HbA1c change (MD -0.40%, 95% CI -0.73% to -0.06%; very low-certainty evidence). Death, serious hypoglycaemia, adverse events other than hypoglycaemia, treatment satisfaction and HRQoL were not evaluated. One trial compared drug dosage reduction with usual care. The evidence is very uncertain about the effect of drug dosage reduction on hypoglycaemia (19/452 versus 52/226, RR 0.18, 95% CI 0.11 to 0.30; very low-certainty evidence). No participants experienced adverse events other than hypoglycaemia during the study (very low-certainty evidence). Death, serious hypoglycaemia, treatment satisfaction, HbA1c change and HRQoL were not evaluated. AUTHORS' CONCLUSIONS There is no clear evidence of the benefits or harms of interventions for individuals with T2DM who fast during Ramadan. All results should be interpreted with caution due to concerns about risk of bias, imprecision and inconsistency between studies, which give rise to low- to very low-certainty evidence. Major outcomes, such as mortality, health-related quality of life and severe hypoglycaemia, were rarely evaluated. Sufficiently powered studies that examine the effects of various interventions on these outcomes are needed.
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Affiliation(s)
| | - Won Sun Chen
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Hawthorn, Australia
- Curtin Medical School, Curtin University, Bentley WA 6102, Australia
| | - Renukha Sellappans
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
| | | | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich-Heine University, Düsseldorf, Germany
| | - Nai Ming Lai
- School of Medicine, Taylor's University, Subang Jaya, Malaysia
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Sheikh A, Das B, Sattar S, Islam N. Safety of sodium-glucose cotransporter 2 inhibitors (SGLT2i) during the month of Ramadan in patients with type 2 diabetes mellitus in Pakistani population-an observational study from a tertiary care center in Karachi. Endocrine 2023; 80:64-70. [PMID: 36580199 PMCID: PMC9798932 DOI: 10.1007/s12020-022-03290-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/19/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Primary aim was to assess the safety of SGLT2-i in patients with Type 2 Diabetes Mellitus (T2D) in a real-life scenario during Ramadan by finding the frequency and severity of hypoglycemic/hyperglycemic events, dehydration, and Diabetic ketoacidosis (DKA). Secondary aim was to assess changes in glycated hemoglobin (HbA1c), weight and creatinine levels. METHODS This prospective, observational, controlled cohort study was conducted at Aga Khan University Hospital, Karachi, Pakistan from March 15 to June 30, 2021. Participants were over 21 years of age, on stable doses of SGLT2-I, which was started at least 2 months before Ramadan. Endpoint assessments were done 1 month before and within 6 weeks after Ramadan. RESULTS Of 102 participants enrolled, 82 completed the study. Most (52%) were males, with mean age 52.2 ± 9.5 years and average duration of T2D 11.2 ± 6.5 years. 63% were on Empagliflozin (mean dose; 14.8 ± 7.2 mg/day) whereas 37% were on Dapagliflozin (mean dose; 8.2 ± 2.7 mg/day). Six (7.3%) documented symptoms of hypoglycemia. However, no episode of severe hypoglycemia, hyperglycemia, dehydration, DKA, hospitalization or discontinuation of SGLT2i was reported. HbA1c changes were (7.7 ± 1.2% from 7.9 ± 2.3%, p 0.34), weight (78.4 ± 12.9 kgs from 78.9 ± 13.3, p 0.23) and eGFR (87.8 ± 27.9 from 94.3 ± 37.6, p < 0.001). The reasons of study participants drop outs were: six did not keep any fasts; four discontinued study participation for personal reasons; three were out of city and missed post Ramadan follow-up, two protocol violation and five could not be contacted for post-Ramadan follow up during the third wave of COVID-19. CONCLUSION Results showed the safety of SGLT2i agents during Ramadan in the Pakistani population recommending it as a treatment option in adults with T2D, without any additional adverse events.
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Affiliation(s)
- Aisha Sheikh
- Section of Endocrinology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
| | | | - Saadia Sattar
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Najmul Islam
- Section of Endocrinology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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El-Taravi Y, Baimukhambetova DV, Gorlenko CL, Kiseljow HY, Kokhanovskaia II, Burotina AI, Rassadina ES, Martirosian NS, Petunina NA. Management of diabetes during Ramadan: an update for Russian-speaking doctors. Diabetes mellitus 2023. [DOI: 10.14341/dm12972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Fasting during the Islamic Ramadan month is one of the five obligatory pillars for each adult, healthy, and sane Muslim. People with severe illnesses, including type 1 and type 2 diabetes mellitus are exempt from fasting. However, many Muslims often insist on Ramadan participating despite any medical advises. It’s known that Muslims are the second largest religious group in Russia; thus, its crucial to have as much modern recommendation for management patients with type 1 and type 2 diabetes mellitus as possible. The aim of this narrative review is to evaluate physiological and pathophysiological metabolism changing during holy Ramadan month, to clarify the management of patients with type 1 and type 2 diabetes mellitus during Ramadan, to determine the frequency of glucose measuring during the day, and to understand when its time to interrupt the fasting. Moreover, we discuss specific recommendations in glucose-lowering therapy changing, nutrition, physical activities and education.
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Affiliation(s)
- Y.A. El-Taravi
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | - C. L. Gorlenko
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - H. Yu. Kiseljow
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | - A. I. Burotina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - E. S. Rassadina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - N. S. Martirosian
- I.M. Sechenov First Moscow State Medical University (Sechenov University); L.A. Vorokhobov City Clinical Hospital No. 67
| | - N. A. Petunina
- I.M. Sechenov First Moscow State Medical University (Sechenov University); L.A. Vorokhobov City Clinical Hospital No. 67
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Goh KG, Zakaria MH, Raja Azwan RN, Bhajan Singh KK, Badrul Hisham MH, Hussein Z. Effect of empagliflozin in patients with type 2 diabetes during Ramadan on volume status, ketonaemia, and hypoglycaemia. Diabetes Metab Syndr 2023; 17:102680. [PMID: 36473336 DOI: 10.1016/j.dsx.2022.102680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/03/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Patients with type 2 diabetes (T2D) carry higher risk of glycaemic variability during Ramadan. Glucose-lowering medications such as SGLT2 inhibitors are also associated with genitourinary infection, acute kidney injury, and euglycaemic diabetic ketoacidosis. Limited data is available on the effects of SGLT2 inhibitors on T2D patients during Ramadan. We investigated effects of empagliflozin use in fasting T2D patients. METHODS This was a prospective cohort study in a single diabetes centre in Malaysia. Empagliflozin group were on study drug for at least three months. For control group, subjects not receiving SGLT2 inhibitors were recruited. Follow-up were performed before and during Ramadan fasting. Anthropometric measurements, blood pressure, renal profile, and blood ketone were recorded during visits. Hypoglycaemia symptoms were assessed via hypoglycaemia symptom rating questionnaire (HypoSRQ). RESULTS We recruited a total of 98 subjects. Baseline anthropometry, blood pressure, and renal parameters were similar in two groups. No significant changes in blood pressure, weight, urea, creatinine, eGFR, or haemoglobin levels during Ramadan was found in either group. Likewise, no difference was detected in blood ketone levels (empagliflozin vs control, 0.17 ± 0.247 mmol/L vs 0.13 ± 0.082 mmol/L, p = 0.304) or hypoglycaemia indices (empagliflozin vs control, 19.1% vs 16%, p = 0.684). CONCLUSIONS Ramadan fasting resulted in weight loss and reduction in eGFR levels in patients with T2D. Empagliflozin use during Ramadan is safe and not associated with increased risk of dehydration, ketosis, or hypoglycaemia. Therefore, empagliflozin is a viable glucose-lowering drug for patients with T2D planning for Ramadan fasting.
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Affiliation(s)
- Kian Guan Goh
- Endocrine Unit, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia.
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Ahmed M, Badi S, Elidrisi A, Husain NE, Zainudin SB, Mahmood A, Abubaker NE, Alghamdi AS, Ahmed MH. Safety and effectiveness of newer antidiabetic medications during Ramadan fasting and safety of Ramadan fasting after bariatric surgery. J Diabetes Metab Disord 2022; 21:1991-2004. [PMID: 36404821 PMCID: PMC9672258 DOI: 10.1007/s40200-022-01145-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/10/2022] [Indexed: 11/27/2022]
Abstract
Background Fasting during Ramadan is mandatory for all adult healthy Muslims. International studies found that most Muslims with diabetes mellitus fast during Ramadan. The main risk factors are hypoglycemia, Hyperglycemia, diabetic ketoacidosis, and dehydration during fasting. Therefore, stratification of the risks for severe acute diabetes complications needs to be considered for each individual and strategies personalized to advert these complications. The advent of new diabetes medications which are effective yet with a better safety profile and monitoring of blood glucose levels during the day are important to reduce the risk of untoward effects of hypoglycemia and hyperglycemia during Ramadan fasting. Here we review the safety and effectiveness of the newer diabetes medications for Ramadan fasting and whether it is safe to perform fasting after bariatric surgery. Methods An extensive literature search using PubMed and Google Scholar was done using different search terms. The eligible studies were 48 randomized controlled trials, prospective observational studies, and reviews from January 2008 to June 2022 which were conducted in individuals living with diabetes. Results and Conclusions The newer diabetes medications such as GLP-1 agonists, DPP-4 inhibitors, SGLT-2 inhibitors, and new Insulin therapy are thought to be safe and effective during fasting of Ramadan. These medications are associated with a reduction in HbA1c, body weight, systolic blood pressure and risk of hypoglycemia during Ramadan fasting. However, further studies with larger sample size are needed to confirm the efficacy and safety of these newer medications during Ramadan fasting. Individuals with Bariatric surgery should seek advice and approval to fast from the bariatric dietician, physician, and surgeon before the beginning of the month of Ramadan.
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Affiliation(s)
- Musaab Ahmed
- College of Medicine, Ajman University, Ajman, United Arab Emirates
- Center of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Safaa Badi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Omdurman Islamic University, Khartoum, Sudan
| | - Ala Elidrisi
- Department of Pathology, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Khartoum, Sudan
| | - Nazik Elmalaika Husain
- Department of Pathology, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Khartoum, Sudan
| | | | - Arshad Mahmood
- Department of Colorectal Surgery, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire UK
| | - Nuha Eljaili Abubaker
- Clinical Chemistry Department, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan
| | | | - Mohamed H. Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire UK
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Rong X, Zhu Y, Wen B, Liu K, Li X, Gou Q, Chen X. Risk of hypovolemia associated with sodium-glucose cotransporter-2 inhibitors treatment: A meta-analysis of randomized controlled trials. Front Cardiovasc Med 2022; 9:973129. [PMID: 36451919 PMCID: PMC9701837 DOI: 10.3389/fcvm.2022.973129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 10/26/2022] [Indexed: 01/26/2024] Open
Abstract
AIM OF THE REVIEW To assess the risk of hypovolemia for sodium-glucose cotransporter-2 (SGLT2) inhibitors treatment. METHOD A systematic literature retrieval was performed in PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Scopus from inception up to 4 October 2022, Data for study characteristics and outcomes of interest were extracted from each eligible study. Risk ratios (RRs) with a 95% confidence interval (CI) for hypovolemia were calculated using a random-effect model. RESULTS A total of 57 studies (n = 68,622) were included in our meta-analysis, with a result of 1,972 hypovolemia incidents (1,142 in the SGLT2 inhibitors group and 830 in the control group). The pooled RR was 1.12 (95% CI: 1.02-1.22). It is evident that receiving SGLT2 inhibitors increased the risk of hypovolemia. When stratified by category of SGLT2 inhibitors the result was consistent; when the subgroup was analyzed by age, the pooled RR was 1.07 (95% CI: 0.94-1.23) in patients aged ≥65 years and 1.14 (95% CI: 1.02-1.28) in those aged <65 years. When comparing the baseline estimated glomerular filtration rate (eGFR) of less than or equal to 60 mL/min/1.73 m2 with a baseline eGFR greater than 60 mL/min/1.73 m2, the pooled RR was 1.21, (95% CI: 1.00-1.46) and 1.08, (95%CI: 0.98-1.20), respectively. CONCLUSION Our meta-analysis has demonstrated that SGLT2 inhibitors increased the risk of hypovolemia in patients with Type 2 Diabetes Mellitus (T2DM). It is necessary to pay attention to the risk of hypovolemia associated with SGLT2 inhibitors, especially in older individuals and those with moderate renal impairment. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/], identifier [CRD42020156254].
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Affiliation(s)
- Xi Rong
- Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, China
| | - Yawen Zhu
- Department of General Practice, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Wen
- dMed Biopharmaceutical Company Limited, Shanghai, China
| | - Kai Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xinran Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiling Gou
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Yousuf S, Ahmedani MY. Efficacy and safety of empagliflozin in people with type 2 diabetes during Ramadan fasting. Diabetes Metab Syndr 2022; 16:102633. [PMID: 36279701 DOI: 10.1016/j.dsx.2022.102633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS To explore efficacy and safety of empagliflozin in people with type2 diabetes during Ramadan fasting METHODS: People with type2 diabetes (T2DM) who were taking empagliflozin and sulphonylurea with or without a metformin and dipeptidyl peptidase inhibitors (DPP4) recruited a month before Ramadan. Glycated hemoglobin (HbA1c) and estimated glomerular filtration rate (eGFR) were recorded pre- and post-Ramadan. A predesigned diary was given to the participants to keep track of their T2DM status during Ramadan. The proportion of the people who had hypoglycaemia, or any adverse event related to the study drug was assessed after-Ramadan. RESULTS A total of 116 participants completed the study. Symptomatic episodes of hypoglycaemia were more common among people who used sulphonylurea (i.e., 8.6%). Genitourinary infections and volume depletion events were recorded more in people on empagliflozin i.e., (6.9% and 5.17%, respectively). A significant reduction in body mass index (BMI), and HbA1c was noted among people on empagliflozin post Ramadan. A significant reduction in eGFR was noted only in people who were taking empagliflozin in combination with metformin. CONCLUSION Empagliflozin was found to be safe and effective in fasting people with T2DM. Further large-scale studies are needed to validate our findings.
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Affiliation(s)
- Sanobia Yousuf
- Research Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan.
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Davidson JA, Sukor N, Hew F, Mohamed M, Hussein Z. Safety of sodium-glucose cotransporter 2 inhibitors in Asian type 2 diabetes populations. J Diabetes Investig 2022; 14:167-182. [PMID: 36260389 PMCID: PMC9889611 DOI: 10.1111/jdi.13915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/02/2022] [Accepted: 09/10/2022] [Indexed: 02/04/2023] Open
Abstract
The prevalence of type 2 diabetes mellitus continues to increase in many Asian countries, with possible contributing factors, such as younger-onset disease, diabetes development at lower body mass index, higher visceral fat accumulation and poorer β-cell function, among Asian populations. Sodium-glucose cotransporter 2 inhibitors have been shown to confer favorable effects in type 2 diabetes mellitus patients, such as improved glycemic control, weight and blood pressure reduction, and importantly, cardiorenal benefits. Sodium-glucose cotransporter 2 inhibitors are generally well-tolerated, and have a well-defined safety profile based on evidence from numerous clinical trials and post-marketing pharmacovigilance reporting. To our knowledge, this review is the first to provide a comprehensive coverage of the adverse events of sodium-glucose cotransporter 2 inhibitors, as well as their management and counseling aspects for Asian type 2 diabetes mellitus populations.
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Affiliation(s)
- Jaime A Davidson
- Touchstone Diabetes CenterThe University of Texas Southwestern Medical CenterDallasTexasUSA
| | - Norlela Sukor
- Universiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
| | - Fen‐Lee Hew
- Subang Jaya Medical CentreSubang JayaSelangorMalaysia
| | - Mafauzy Mohamed
- School of Medical SciencesUniversiti Sains MalaysiaKelantanMalaysia
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Ahmed I, Raja UY, Wahab MU, Rehman T, Ishtiaq O, Aamir AH, Ghaffar T, Raza A, Kumar S, Sherin A, Masood F, Randhawa FA, Asghar A, Khan S. Efficacy and safety of combination of empagliflozin and metformin with combination of sitagliptin and metformin during Ramadan: an observational study. BMC Endocr Disord 2022; 22:247. [PMID: 36224542 PMCID: PMC9560019 DOI: 10.1186/s12902-022-01168-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Management of diabetes during fasting is a clinical challenge. Sodium glucose co-transporter -2 inhibitors (SGLT2i) are considered safe with a low risk of hypoglycemia. However, studies on SGLT2i are scarce. This study was designed to compare the efficacy, safety, and tolerability of empagliflozin with metformin during Ramadan in comparison with sitagliptin and metformin. METHODS It was a prospective, observational study, conducted at 11 different sites all across Pakistan on an outpatient basis during Ramadan (May 2021-June 2021). including 132 patients, 88 who received metformin and sitagliptin, and 44 patients who received metformin and empagliflozin. RESULTS Patients of the SGLT-2i group experienced similar symptomatic hypoglycemic episodes (15.9%) as the sitagliptin group. There was an improvement in blood sugar levels after the use of SGLT-2i (RBS 181 ± 64 before Ramadan vs 162 ± 53 after Ramadan). HbA1c also improved after the use of SGLT-2i before and after Ramadan (7.2 ± 0.8 vs 6.9 ± 0.9 for Metformin + Empagliflozin and 7.8 ± 1.5 vs 7.6 ± 1.6 for Metformin and sitagliptin). Weight and BMI improved after the use of SGLT-2i (BMI 36.5 ± 4.8 before Ramadan and 33.7 ± 2.4 after Ramadan). There were no reported cases of urinary tract infection in the empagliflozin group. CONCLUSION SGLT-2 inhibitors combined with metformin for patients with diabetes during Ramadan fasting is as effective, safe and well tolerated as DPP4 combined with metformin.
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Affiliation(s)
- Ibrar Ahmed
- Lady Reading Hospital, Soekarno Rd, PTCL Colony, Peshawar, House No 6A, Street 2, Akbar Town Danishabad, Near Academy Hostel, Peshawar, Khyber Pakhtunkhwa Pakistan
| | - Umar Yousaf Raja
- Shifa International, Pitras Bukhari Road, Sector H-8/4, Islamabad, Pakistan
| | - Muhammad Umar Wahab
- Umer Diabetes and Foot Clinic, Malak shafait plaza, Mauza Mahal kot, Hathial, Main Murree Rd, Bhara Kahu, Islamabad, Pakistan
| | - Tejhmal Rehman
- Shifa International, Pitras Bukhari Road, Sector H-8/4, Islamabad, Pakistan
| | - Osama Ishtiaq
- Shifa International, Pitras Bukhari Road, Sector H-8/4, Islamabad, Pakistan
| | - A. H. Aamir
- Hayatabad Medical Complex, Phase-4 Phase 4 Hayatabad, Peshawar, Khyber Pakhtunkhwa Pakistan
| | - Tahir Ghaffar
- Hayatabad Medical Complex, Phase-4 Phase 4 Hayatabad, Peshawar, Khyber Pakhtunkhwa Pakistan
| | - Abbas Raza
- Shaukat Khanum Hospital, 153-E, Shah Noor Park (adjacent Clinix Pharmacy Head Office), Main Multan Road, Lahore, Pakistan
| | - Suresh Kumar
- Bolan Medical, Brewery Rd, Quetta, Balochistan Pakistan
| | - Akhtar Sherin
- KMU Institute of Medical Sciences, KIMS, Phase 2, KDA, Khyber Pakhtoonkhwa, Phase 2 Kohat Development Authority (KDA), Kohat Development Authority, KohatKohat, Khyber Pakhtunkhwa Pakistan
| | - Faisal Masood
- Alkhaliq Hospital, Nishtar Rd، Al Rahim Colony, Multan, Punjab Pakistan
| | | | - Ali Asghar
- Liaquat National Hospital, National Stadium Rd, Liaquat National Hospital, Karachi, Karachi City, Sindh Pakistan
| | - Sehrish Khan
- Liaquat National Hospital, National Stadium Rd, Liaquat National Hospital, Karachi, Karachi City, Sindh Pakistan
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Gameil MA, Marzouk RE, El-Sebaie AH, Eldeeb AAA. Influence of sodium-glucose Co-transporter 2 inhibitors on clinical and biochemical markers of dehydration during the Holy Ramadan. Diabetes Metab Syndr 2022; 16:102606. [PMID: 36063675 DOI: 10.1016/j.dsx.2022.102606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Alteration of the hydration status with the use of sodium-glucose co-transporter- 2 inhibitors (SGLT2i) during the Holy Ramadan has not been studied in depth. Precisely, we aimed to detect the potential alteration of hydration status in adult Muslims with type 2 diabetes mellitus (T2D) who used SGLT2i during Ramadan. METHODS An observational non-interventional study included 245 patients with type 2 diabetes mellitus of matched age and sex. The study included 3 groups: empagliflozin group; 87 patients, dapagliflozin group; 85 patients and control group; 73 patients without the use of SGLT2i. Participants in each group were well-settled on their medications for more than 3 months before the onset of Ramadan. Clinical and biochemical parameters of hydration status were evaluated during the last week of Ramadan. RESULTS We noticed a higher prevalence of orthostatic dizziness and postural hypotension among SGLT2i users than non-SGLT2i users (p < 0.001). The mean arterial blood pressure was significantly lowered among users of empagliflozin and dapagliflozin than non-SGLT2i users; 93.7 ± 5.1 and 93.1 ± 6.9 versus 106.2 ± 4.3, p < 0.001, respectively. Moreover, patients who used empagliflozin or dapagliflozin exhibited significantly higher values of urine specific gravity; 1029.6 ± 1.5 and 1029.1 ± 1.6 versus 1016.9 ± 4.4, p < 0.001, serum osmolality; 300.7 ± 10.2 and 297.8 ± 8.9 versus 290.9 ± 6.7, p < 0.001, and BUN/creatinine ratio; 24.1 ± 4.1 and 23.2 ± 4.6 versus 16.3 ± 4.2, p < 0.001 than non-SGLT2i users. CONCLUSION Significant clinical and biochemical markers of dehydration were noticed among users of SGLT2i during the Holy Ramadan.
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Affiliation(s)
- Mohammed Ali Gameil
- Internal Medicine, Endocrinology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt.
| | - Rehab Elsayed Marzouk
- Lecturer of Medical Biochemistry, Medical Biochemistry Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt.
| | - Ahmed Hassan El-Sebaie
- Clinical Pathology, Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt.
| | - Ahmed Ahmed Ahmed Eldeeb
- Internal Medicine, Nephrology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt.
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Kacimi SEO, Sukaina M, Elgenidy A, Farahat RA, Cheema HA, Benmelouka AY, Awad DM, Belaouni HA, Abdelli MK, Tidjane A, Mesli NS, Shah J, Setti MO, Afifi AM, Ghozy S, the Ramadan Diabetes Research Group (RDRG) Collaborators. Hypoglycemic Events in Diabetic Patients under Non-insulin Regimens During Ramadan: A Frequentist Network Meta-Analysis.. [DOI: 10.1101/2022.05.28.22275730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
AbstractBackgroundDiabetic 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.MethodsWe 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.ResultsNine 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).ConclusionSGLT-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.Abstract Figure
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Gad H, Al‐Nassr N, Mohammed I, Khan A, MacDonald R, Mussleman P, Malik RA. Effect of Ramadan fasting in patients with type 2 diabetes mellitus treated with sodium-glucose cotransporter 2 inhibitors: A systematic review and meta-analysis. J Diabetes Investig 2022; 13:822-829. [PMID: 34953158 PMCID: PMC9077738 DOI: 10.1111/jdi.13741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/05/2021] [Accepted: 12/12/2021] [Indexed: 11/27/2022] Open
Abstract
AIMS/INTRODUCTION Sodium-glucose cotransporter 2 inhibitors (SGLT-2i) improve glycemic control and weight, but might be associated with dehydration, hypotension and ketoacidosis, especially in patients with type 2 diabetes mellitus who fast during Ramadan. This meta-analysis evaluates the effects of Ramadan fasting on patients with type 2 diabetes mellitus treated with SGLT-2i. MATERIALS AND METHODS A literature search was carried out in PubMed, Embase and the Cochrane Library. Quality assessment was carried out using the ROBINS-I and Cochrane tools for risk of bias, and analyses were carried out using RevMan version 5.3. RESULTS A total of five studies were included in this meta-analysis. During Ramadan, there was a significant reduction in glycated hemoglobin (P < 0.00001) and diastolic blood pressure (P = 0.006), with a non-significant trend for a reduction in weight (P = 0.44) and systolic blood pressure (P = 0.67). The number and severity of hypoglycemic episodes was lower in patients with type 2 diabetes mellitus treated with SGLT-2i compared with sulfonylureas. There was no significant change in estimated glomerular filtration rate, β-hydroxybutyrate, bicarbonate or anion gap. However, we identified considerable heterogeneity among studies, and a lack of head-to-head studies with structured outcome reporting on the risks and benefits of SGLT-2i during Ramadan. CONCLUSIONS This systematic review and meta-analysis shows that patients with type 2 diabetes treated with SGLT2i's during Ramadan have an improvement in HbA1c, less hypoglycemia and no major adverse effects.
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Affiliation(s)
- Hoda Gad
- Department of MedicineWeill Cornell Medicine‐QatarDohaQatar
| | - Noor Al‐Nassr
- Department of MedicineWeill Cornell Medicine‐QatarDohaQatar
| | | | - Adnan Khan
- Department of MedicineWeill Cornell Medicine‐QatarDohaQatar
| | | | | | - Rayaz A. Malik
- Department of MedicineWeill Cornell Medicine‐QatarDohaQatar
- Institute of Cardiovascular MedicineUniversity of ManchesterManchesterUK
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Shiju R, Akhil A, Thankachan S, Tuomilehto J, Al Arouj M, Bennakhi A. Safety Assessment of Glucose-Lowering Drugs and Importance of Structured Education during Ramadan: A Systematic Review and Meta-Analysis. J Diabetes Res 2022; 2022:3846253. [PMID: 35242880 PMCID: PMC8886741 DOI: 10.1155/2022/3846253] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Ramadan is the sacred month of the Islamic Hijri (lunar) calendar, and during this entire month, healthy adult Muslims abstain from eating and drinking from dawn to sunset. Muslims with Type 2 Diabetes Mellitus (T2DM) who choose to fast during Ramadan encounter major risks such as hypoglycemia, hyperglycemia, diabetic ketoacidosis, dehydration, and thrombosis. Although patients with poor glycemic control and on multiple insulin injections are at high risk and exempt from fasting, many still insist on it. Thus, healthcare professionals play a pivotal role in managing diabetes-related complications in patients who fast during Ramadan. However, there is a lack of standard guidelines to be followed in association with structured education and administration of drugs and dosage. Therefore, we performed a systematic review and meta-analysis of the literature to determine the safety and efficacy of different classes of drugs and the importance of structured education during Ramadan. METHODS In this review, an extensive PubMed search was performed to obtain literature on T2DM patients who fast during the month of Ramadan until the year 2020. Preference was given to fully downloadable articles. The articles were extracted based on the eligibility criteria. The extracted data were analyzed using Review Manager software version 5.3. RESULTS A total of 32 articles were included for the review and 7 studies for meta-analysis. Majority of the studies demonstrated the importance of structured education either as a group session or as a one-on-one session with the healthcare professionals in preventing diabetes-related risks during Ramadan. As far as glucose-lowering drugs are concerned, DPP-4 inhibitor combined with metformin remains the drug of choice for T2DM patients who fast during Ramadan. The newer class of glucose-lowering agents appear to lower the risk of hypoglycemia in comparison with sulphonylureas, while among sulphonylureas gliclazide is relatively safe. The meta-analysis indicates that DPP-4 inhibitors would significantly reduce the risk of hypoglycemia as compared to sulphonylurea (odds ratio = 0.38, 95% CI: 0.26 to 0.55, p < 0.00001). CONCLUSION The results of our systematic review show that structured education and counselling by healthcare professionals can be an effective tool in preventing complications associated with fasting during Ramadan in people with T2DM. Additionally, the safest class of oral glucose-lowering drugs preferred during Ramadan fasting in T2DM patients is DPP-4 inhibitors.
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Affiliation(s)
- Rashmi Shiju
- Office of Regulatory Affairs, Dasman Diabetes Institute, Kuwait
| | - Ayesha Akhil
- Office of Regulatory Affairs, Dasman Diabetes Institute, Kuwait
| | | | - Jaakko Tuomilehto
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Public Health Prevention Unit, Finnish Institute for Health and Welfare, Finland
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
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Pathan MDF, Akter N, Selim S, Saifuddin M, Qureshi NK, Kamrul-Hasan ABM, Hannan MA, Ahmed MAU, Mustari M, Chakraborty AK. Efficacy and Safety of Empagliflozin in Patients with Type 2 Diabetes Mellitus Fasting During Ramadan: A Real-World Study from Bangladesh. Diabetes Metab Syndr Obes 2022; 15:4011-4021. [PMID: 36578878 PMCID: PMC9791934 DOI: 10.2147/dmso.s380544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
AIM In Bangladesh, there is a large population of Muslims with type 2 diabetes mellitus (T2DM) who fast during Ramadan. Changes in the pattern of meal and fluid intake during this long-fasting hours may increase the risk of hypoglycaemia, hyperglycaemia, and dehydration. Our key point of focus was to evaluate the efficacy and safety of Empagliflozin, a sodium-glucose co transporter 2 inhibitor (SGLT2i), in patients with T2DM while fasting during Ramadan. METHODS This was a 24-weeks, multi-centre, open-label, two-arm parallel-group study. In this prospective type of observational study, we enrolled patients taking Empagliflozin and Metformin with or without a DPP-4 inhibitor in one group (n = 274) and a parallel group (n = 219) who were treated with Metformin with or without a DPP-4 inhibitor. The primary endpoint of this study was HbA1c reduction, weight loss and the number of reported or symptomatic hypoglycemic events. In secondary endpoints, we evaluated the changes from baseline in blood pressure, estimated glomerular filtration rate (eGFR), serum creatinine, and serum electrolyte, the proportion of volume depletion (≥1 event) and incidence of other adverse events (AEs) of interest potentially related to SGLT2 inhibitor. RESULTS During Ramadan, HbA1c reduction was significant in Empagliflozin arm (-0.49% vs -0.12%); [p < 0.001]. From before to the end of the study, significant weight reduction was seen in the Empagliflozin arm (-1.4 kg vs -0.09 kg); [p < 0.001]. We observed no significant increase in the incidence of hypoglycemia (0.7% vs 0.4%, p = 0.267) and volume depletion (2.6% vs 1.8%; p = 0.55) in both arm. All these milder forms events did not require any hospital admission. There was no report of serious adverse events or any discontinuation, or reduction of prescribed doses of empagliflozin during Ramadan. CONCLUSION Empagliflozin is efficacious and safe for treating adults with T2DM during Ramadan.
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Affiliation(s)
- M D Faruque Pathan
- BIRDEM General Hospital, Dhaka, Bangladesh
- Correspondence: MD Faruque Pathan, BIRDEM General Hospital, 122 Kazi Nazrul Islam Avenue, Dhaka, 1000, Bangladesh, Tel +8801713032888, Email
| | - Nazma Akter
- MARKS Medical College & Hospital, Dhaka, Bangladesh
| | - Shahjada Selim
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | | | | | | | | | - Marufa Mustari
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Gad H, Hayat T, Al-Muhannadi H, Malik BR, Mussleman P, Malik RA. Efficacy and safety of the newer oral hypoglycemic agents in patients with T2DM during Ramadan: A systematic review and meta-analysis. Diabetes Res Clin Pract 2021; 172:108562. [PMID: 33271228 DOI: 10.1016/j.diabres.2020.108562] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
AIMS This systematic review and meta-analysis aims to evaluate the safety and efficacy of the newer glucose lowering treatments on glycemic control, weight, blood pressure and hypoglycemia in patients with T2DM during Ramadan. METHODS A literature search was done in PubMed, Embase, and the Cochrane Library. Quality assessment was done using the ROBINS-I and Cochrane tools for risk of bias and analyses were performed using RevMan version 5.3. RESULTS A total of 20 studies were included in the meta-analysis. Dipeptidyl peptidase-4 inhibitors (DPP-4i) led to a significant reduction in HbA1c (%) (SMD -0.25) and a non-significant decrease in weight (kg) (SMD -1.06) during Ramadan. Glucagon-like peptide (GLP-1) agonist therapy was associated with a significant decrease in HbA1c (%) (SMD -0.68) and a non-significant decrease in weight (kg) (SMD -2.57) and systolic blood pressure (SBP) (mmHg) (SMD -3.50) after Ramadan. Sodium-glucose co-transporter 2 inhibitor (SGLT-2i) therapy was associated with a significant decrease in HbA1c (%) (SMD -0.51) and a non-significant decrease in weight (kg) (SMD -1.41), SBP (SMD -1.10) and diastolic blood pressure (DBP) (mmHg) (SMD -2.08) after Ramadan. CONCLUSIONS This systematic review and meta-analysis shows clinical benefits with the newer glucose lowering medications in patients with T2DM who fast during Ramadan.
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Affiliation(s)
- Hoda Gad
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Tabraiz Hayat
- Family Medicine, Leabaib Health Center, Primary Health Care Corporation, Doha, Qatar
| | | | - Balal Rasheed Malik
- Mobile Healthcare Service, Ambulance Department, Hamad Medical Corporation, Doha, Qatar
| | - Paul Mussleman
- Library Services, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar; Institute of Cardiovascular Medicine, University of Manchester, Manchester, United Kingdom.
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Abdelrahim D, Faris ME, Hassanein M, Shakir AZ, Yusuf AM, Almeneessier AS, BaHammam AS. Impact of Ramadan Diurnal Intermittent Fasting on Hypoglycemic Events in Patients With Type 2 Diabetes: A Systematic Review of Randomized Controlled Trials and Observational Studies. Front Endocrinol (Lausanne) 2021; 12:624423. [PMID: 33763029 PMCID: PMC7984365 DOI: 10.3389/fendo.2021.624423] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/11/2021] [Indexed: 01/14/2023] Open
Abstract
Ramadan is the 9th month of the lunar calendar during which Muslims abstain from food and drink between dawn and sunset for 30 consecutive days. Ramadan fasting is observed by all healthy Muslim adults, as well many Muslims with type 2 diabetes (T2DM). Hypoglycemic events (HE) are a serious complication associated with diabetes management and are associated with increased cardiovascular disease risk. Conflicting results have been reported concerning the incidence of HE among people with T2DM observing Ramadan fasting. This review summarizes available scientific evidence on the occurrence of HE and the effects of different moderators on the incidence of HE among patients with T2DM during Ramadan. We conducted a systematic review of available observational studies and randomized controlled trials (RCTs) for patients with T2DM who fasted during Ramadan, with HE as the primary outcome. Ten databases were searched for relevant studies from inception until October 31, 2020. In total, 68 studies (35 RCTs and 33 observational studies) met the inclusion criteria. Non-sulfonylureas hypoglycemic medications showed superior effects in lowering the incidence of HE over sulfonylureas hypoglycemic medications. Variable moderators were associated with experiencing HE during Ramadan in both observational studies and RCTs, including sex, geographical location, body anthropometric indicators, season, dietary behaviors, fasting duration, time since diagnosis, and pre-fasting education. This comprehensive systematic review covered the largest number of observational and clinical studies investigating the impact of Ramadan on HE among patients with T2DM. The study highlights the significance of different moderators that influence the effect of Ramadan fasting on HE, including dietary behaviors, fasting time duration, sex, season, country, pre-fasting education, age, and time since diagnosis. The study also highlighted the impact of different hypoglycemic medications on HE and noted the superiority of non-sulfonylureas over sulfonylureas hypoglycemic medications in lowering the risk for hypoglycemia in people with T2DM during Ramadan fasting.
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Affiliation(s)
- Dana Abdelrahim
- Department of Nutrition and Food Technology, Faculty of Agriculture, The University of Jordan, Amman, Jordan
| | - MoezAlIslam E. Faris
- Department of Clinical Nutrition and Dietetics, College of Health Sciences/Research Institute for Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
- *Correspondence: Ahmed S. BaHammam, ; MoezAlIslam E. Faris, ;
| | - Mohamed Hassanein
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Ayman Z. Shakir
- Department of Clinical Nutrition and Dietetics, College of Health Sciences/Research Institute for Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Ayesha M. Yusuf
- Department of Clinical Nutrition and Dietetics, College of Health Sciences/Research Institute for Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | | | - Ahmed S. BaHammam
- Department of Medicine, College of Medicine, The University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia
- *Correspondence: Ahmed S. BaHammam, ; MoezAlIslam E. Faris, ;
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Hassanein M, Bashier A, Randeree H, Abouelmagd M, AlBaker W, Afandi B, Abu Hijleh O, Shaltout I, Ei-Sharkawy M, Dagdelen S, Assaad Khalil S. Use of SGLT2 inhibitors during Ramadan: An expert panel statement. Diabetes Res Clin Pract 2020; 169:108465. [PMID: 32971151 DOI: 10.1016/j.diabres.2020.108465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/31/2020] [Accepted: 09/16/2020] [Indexed: 01/17/2023]
Abstract
Fasting from dawn to sunset, during the holy month of Ramadan, constitutes one of the five main pillars in Islam and is observed by the majority of Muslims. Owing to important physiological changes, Ramadan fasting holds a crucial place in the context of diabetes management. Approximately one-fifth of the world's Muslim population resides in the Middle East and Africa (MEA) region. To discuss the challenges and management of diabetes during Ramadan fasting in the MEA region, a panel of 12 experts in the field of diabetes from across the MEA region attended two expert committee meetings held in Dubai. The key point of discussion was the safety and efficacy of the use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) during Ramadan, based on outcomes of the recent clinical trials with SGLT2i. This is the first consensus recommendation on the management of diabetes with SGLT2i across the MEA region during Ramadan. The document summarizes expert views and opinions on the current management of diabetes with SGLT2i during Ramadan and aims to enhance the current knowledge and understanding on the issue of diabetes management during Ramadan. This will aid the physicians of the MEA region with appropriate decision-making for their patients during Ramadan.
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Affiliation(s)
- Mohamed Hassanein
- Consultant Endocrinology, Dubai Hospital, Dubai, United Arab Emirates.
| | | | | | | | - Waleed AlBaker
- Associate Professor of Medicine, University of Immam Abdulrahman Bin Faisal, Saudi Arabia
| | - Bachar Afandi
- Division Chief, Endocrinology (Diabetic Clinic - Medical Affairs, Tawam Hospital), Abu Dhabi, United Arab Emirates
| | - Omar Abu Hijleh
- Senior Consultant Endocrinologist, Jordan Center for Thyroid, Endocrine Diseases and Diabetes, Jordan Hospital Medical Center, Jordan
| | | | - Magdy Ei-Sharkawy
- Professor, Internal Medicine and Nephrology, Ain Shams University, Cairo, Egypt
| | - Selcuk Dagdelen
- Department of Endocrinology and Metabolism, Hacettepe University School of Medicine, Turkey
| | - Samir Assaad Khalil
- Professor of Endocrinology, Medicine, Alexandria University, Alexandria, Egypt
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Beshyah SA, Hafidh K, Shaikh TG. Evolving physicians' perceptions and practices regarding use of SGLT2 inhibitors for type 2 diabetes during Ramadan fasting. Diabetes Res Clin Pract 2020; 168:108389. [PMID: 32858101 DOI: 10.1016/j.diabres.2020.108389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/19/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES We followed up the evolving perceptions and practices regarding use of SGLT-2 inhibitors in Ramadan. METHODS We compared results of the three survey in 2015, 2017, 2019. RESULTS Senior doctors represented 43.5-66.4% and endocrinologists accounted for 38.1-60.2%. There was a steady reduction in the proportions of respondents who did not know SGLT2-Is at all, who have just heard about the class and those who are quite familiar with the class but have not yet used any. Whereas the proportions of those using the SGLT2-Is class occasionally only was stable. However those who use the SGLT2-Is regularly increased from 11.0% to 45.6% and 62.6%. The respondents' who SGLT2-Is are safe and may be used in all fasting diabetic patients increased from 15.5%, 14.7% to 23.1%. Whereas the view that SGLT2-Is should not be used decreased progressively. Majority of respondents in the three surveys suggested that specific advice is given if they allow the use of SGLT2-Is during Ramadan. More respondents advise taking the medication with the first evening meal than before the last pre-dawn meal and advised to attend to their hydration status. One third of respondents would resume SGLT2-Is immediately after the end of Ramadan; 15% after 1-2 weeks, or prefer to wait till the next medical or educator's clinic visit and others would re-evaluate patients' management plan. CONCLUSIONS The medical professions' knowledge and perceptions regarding the use of SGLT2-Is during Ramadan fasting have evolved over the last few years due to increasing research and experience.
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Affiliation(s)
- Salem A Beshyah
- The Endocrinology Clinic, Mediclinic Airport Road Hospital, Abu Dhabi, United Arab Emirates; Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates.
| | - Khadija Hafidh
- Department of Diabetes and Endocrinology, Rashid Hospital, DHA, Dubai, United Arab Emirates
| | - Tariq Gul Shaikh
- The Endocrinology Clinic, Mediclinic Airport Road Hospital, Abu Dhabi, United Arab Emirates
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Ahmed SH, Chowdhury TA, Hussain S, Syed A, Karamat A, Helmy A, Waqar S, Ali S, Dabhad A, Seal ST, Hodgkinson A, Azmi S, Ghouri N. Ramadan and Diabetes: A Narrative Review and Practice Update. Diabetes Ther 2020; 11:1-44. [PMID: 32922560 PMCID: PMC7480213 DOI: 10.1007/s13300-020-00886-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Indexed: 02/06/2023] Open
Abstract
Fasting in the Islamic month of Ramadan is obligatory for all sane, healthy adult Muslims. The length of the day varies significantly in temperate regions-typically lasting ≥ 18 h during peak summer in the UK. The synodic nature of the Islamic calendar means that Ramadan migrates across all four seasons over an approximately 33-year cycle. Despite valid exemptions, there is an intense desire to fast during this month, even among those who are considered to be at high risk, including many individuals with diabetes mellitus. In this review we explore the current scientific and clinical evidence on fasting in patients with diabetes mellitus, focussing on type 2 diabetes mellitus and type 1 diabetes mellitus, with brief reviews on pregnancy, pancreatic diabetes, bariatric surgery, the elderly population and current practice guidelines. We also make recommendations on the management of diabetes patients during the month of Ramadan. Many patients admit to a do-it-yourself approach to diabetes mellitus management during Ramadan, largely due to an under-appreciation of the risks and implications of the rigors of fasting on their health. Part of the issue may also lie with a healthcare professional's perceived inability to grasp the religious sensitivities of Muslims in relation to disease management. Thus, the pre-Ramadan assessment is crucial to ensure a safe Ramadan experience. Diabetes patients can be risk-stratified from low, medium to high or very high risk during the pre-Ramadan assessment and counselled accordingly. Those who are assessed to be at high to very high risk are advised not to fast. The current COVID-19 pandemic upgrades those in the high-risk category to very high risk; hence a significant number of diabetes patients may fall under the penumbra of the 'not to fast' advisory. We recognize that fasting is a personal choice and if a person chooses to fast despite advice to the contrary, he/she should be adequately supported and monitored closely during Ramadan and for a brief period thereafter. Current advancements in insulin delivery and glucose monitoring technologies are useful adjuncts to strategies for supporting type 1 diabetes patients considered to be high risk as well as 'high-risk' type 2 patients manage their diabetes during Ramadan. Although there is a lack of formal trial data, there is sufficient evidence across the different classes of therapeutic hypoglycaemic agents in terms of safety and efficacy to enable informed decision-making and provide a breadth of therapeutic options for the patient and the healthcare professional, even if the professional advice is to abstain. Thus, Ramadan provides an excellent opportunity for patient engagement to discuss important aspects of management, to improve control in the short term during Ramadan and to help the observants understand that the metabolic gains achieved during Ramadan are also sustainable in the other months of the year by maintaining a dietary and behavioural discipline. The application of this understanding can potentially prevent long-term complications. ELECTRONIC SUPPLEMENTARY MATERIAL The online version of this article (10.1007/s13300-020-00886-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Syed H. Ahmed
- Department of Endocrinology and Metabolic Medicine, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
- School of Medicine, University of Liverpool, Liverpool, UK
| | | | - Sufyan Hussain
- Department of Diabetes and Endocrinology, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- Department of Diabetes, School of Life Course Sciences, King’s College London, London, UK
- Institute of Diabetes, Endocrinology and Obesity, King’s Health Partners, London, UK
| | - Ateeq Syed
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ali Karamat
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ahmed Helmy
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Salman Waqar
- Nuffield Department of Primary Care Health Sciences, University Oxford, Oxford, UK
| | - Samina Ali
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Susan T. Seal
- Department of Endocrinology and Metabolic Medicine, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Anna Hodgkinson
- Department of Diabetes and Endocrinology, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- NHS South East London Clinical Commissioning Group, London, UK
| | - Shazli Azmi
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nazim Ghouri
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Diabetes and Endocrinology, Queen Elizabeth University Hospital, Glasgow, UK
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Chawla R, Madhu SV, Makkar BM, Ghosh S, Saboo B, Kalra S. RSSDI-ESI Clinical Practice Recommendations for the Management
of Type 2 Diabetes Mellitus 2020. Int J Diabetes Dev Ctries 2020. [PMCID: PMC7371966 DOI: 10.1007/s13410-020-00819-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Rajeev Chawla
- North Delhi Diabetes Centre Rohini, New Delhi, India
| | - S. V. Madhu
- Centre for Diabetes, Endocrinology & Metabolism, UCMS-GTB Hospital, Delhi, India
| | - B. M. Makkar
- Dr Makkar’s Diabetes & Obesity Centre Paschim Vihar, New Delhi, India
| | - Sujoy Ghosh
- Department of Endocrinology & Metabolism, Institute of Post Graduate Medical Education & Research, Kolkata, West Bengal India
| | - Banshi Saboo
- DiaCare - A Complete Diabetes Care Centre, Ahmedabad, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana India
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Hanif W, Patel V, Ali SN, Karamat A, Saeed M, Hassanein M, Syed A, Chowdhury TA, Farooqi A, Khunti K. The South Asian Health Foundation (UK) guidelines for managing diabetes during Ramadan. Diabetes Res Clin Pract 2020; 164:108145. [PMID: 32335096 DOI: 10.1016/j.diabres.2020.108145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/04/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Fasting in the holy month of Ramadan is among the five pillars of Islam and is considered as a religious obligation by the Muslim population. People with diabetes observing the practice of fasts are at a higher risk of complications such as hypoglycaemia, hyperglycaemia and ketoacidosis due to changes in eating patterns and circadian rhythms. With the objective of mitigating these complications, the South Asian Health Foundation (UK) has developed the present guidelines based on robust evidence derived from epidemiological studies and clinical trials. METHODS We have highlighted the role of pre-Ramadan risk stratification and counselling by healthcare professionals with emphasis on the need for advice on adequate dietary and fluid intake, blood glucose monitoring and awareness of when to break the fast. RESULTS We reviewed the current literature and have given clinically-relevant recommendations on lifestyle modifications and glucose-lowering therapies such as metformin, sulphonylureas, dipeptidyl peptidase-4 inhibitors, sodium glucose co-transporter-2 inhibitors, thiazolidinediones, glucagon-like peptide-1 receptor agonists and insulin. CONCLUSIONS An individualised patient-centric treatment plan is essential to not only achieve optimal glycaemic outcomes but also enable people with diabetes to observe a risk-free month of fasting during Ramadan.
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Affiliation(s)
- W Hanif
- University Hospital Birmingham. UK.
| | | | - S N Ali
- Department of Diabetes & Endocrinology, Royal Free Hospital, London, UK
| | | | - M Saeed
- University Hospital Birmingham, UK
| | - M Hassanein
- Department of Diabetes and Endocrinology, Dubai Hospital, Dubai, United Arab Emirates
| | - A Syed
- Heartlands Hospital Birmingham, UK
| | | | | | - K Khunti
- Diabetes Research Centre, University of Leicester, UK
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Rong X, Li X, Gou Q, Liu K, Chen X. Risk of orthostatic hypotension associated with sodium-glucose cotransporter-2 inhibitor treatment: A meta-analysis of randomized controlled trials. Diab Vasc Dis Res 2020; 17:1479164120953625. [PMID: 32981346 PMCID: PMC7919209 DOI: 10.1177/1479164120953625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess the association between sodium-glucose cotransporter-2 (SGLT2) inhibitors and the risk of orthostatic hypotension (OH) in patients with type 2 diabetes mellitus (T2DM). METHOD A systematic literature retrieval was performed using PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception up to 16 October 2019. Data for study characteristics and outcomes of interest were extracted from each eligible study. Pooled risk ratios (RRs) with 95% confidence intervals (CI) for OH were calculated using a random-effects model. RESULT A total of 16 studies (n = 12,749) were included in our meta-analysis, with a result of 44 incident OH cases (29 in the SGLT2 inhibitor group, and 15 in the control group). The pooled RR was 1.17 (95% CI: 0.65-2.09). There was no evidence that receiving SGLT2 inhibitors increased the risk of OH, when stratified by age, duration of T2DM, or placebo-control or active-control and baseline blood pressure. CONCLUSION This meta-analysis suggested that, in general, SGLPT2 inhibitors did not increase the risk of OH in patients with T2DM. The possibility of OH should be, therefore, considered on an individual basis, especially in patients with a history of OH, long duration of T2DM, or comorbidities.
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Affiliation(s)
| | | | | | | | - Xiaoping Chen
- Xiaoping Chen, Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
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Ibrahim M, Davies MJ, Ahmad E, Annabi FA, Eckel RH, Ba-Essa EM, El Sayed NA, Hess Fischl A, Houeiss P, Iraqi H, Khochtali I, Khunti K, Masood SN, Mimouni-Zerguini S, Shera S, Tuomilehto J, Umpierrez GE. Recommendations for management of diabetes during Ramadan: update 2020, applying the principles of the ADA/EASD consensus. BMJ Open Diabetes Res Care 2020; 8:e001248. [PMID: 32366501 PMCID: PMC7223028 DOI: 10.1136/bmjdrc-2020-001248] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 12/19/2022] Open
Abstract
Fasting the Holy month of Ramadan constitutes one of the five pillars of the Muslim faith. Although there is some evidence that intermittent fasting during Ramadan may be of benefit in losing weight and cardiometabolic risk factors, there is no strong evidence these benefits apply to people with diabetes. The American Diabetes Association/European Association for the Study of Diabetes consensus recommendations emphasize the importance of patient factors and comorbidities when choosing diabetes medications including the presence of comorbidities, atherosclerotic cardiovascular disease, heart failure, chronic kidney disease, hypoglycemia risk, weight issues and costs. Structured education and pre-Ramadan counseing are key components to successful management of patients with diabetes. These should cover important aspects like glycemic targets, self-monitoring of blood glucose, diet, physical activity including Taraweeh prayers, medication and dose adjustment, side effects and when to break the fast. The decision cycle adapted for the specific situation of Ramadan provides an aid for such an assessment. Children with type 1 diabetes should strongly be advised not to fast due to the high risk of acute complications such as hypoglycemia and probably diabetic ketoacidosis (DKA), although there is very little evidence that DKA is increased in Ramadan. Pregnant women with diabetes or gestational diabetes should be advised to avoid fasting because of possible negative maternal and fetal outcomes. Hypoglycemia is a common concern during Ramadan fasting. To prevent hypoglycemic and hyperglycemic events, we recommend the adoption of diabetes self-management education and support principles. The use of the emerging technology and continuous glucose monitoring during Ramadan could help to recognize hypoglycemic and hyperglycemic complications related to omission and/or medication adjustment during fasting; however, the cost represents a significant barrier.
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Affiliation(s)
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Ehtasham Ahmad
- Diabetes Research Centre, University of Leicester and Leicester General Hospital, Leicester, UK
| | | | - Robert H Eckel
- Division of Endocrinology, Metabolism & Diabetes Division of Cardiology, University of Colorado Denver Anschutz Medical Campus Official Bookstore, Denver, Colorado, USA
| | | | | | - Amy Hess Fischl
- Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, Illinois, USA
| | - Pamela Houeiss
- Division of Endocrinology, American University, Beirut, Lebanon
| | - Hinde Iraqi
- Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - Ines Khochtali
- Department of Endocrinolgy and Internal Medicine, University of Tunisia, Monstair, Tunisia
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Shabeen Naz Masood
- Obstetrics & Gynecology, ISRA Medical University, Karachi, Sindh, Pakistan
| | | | - Samad Shera
- Diabetic Association of Pakistan, Karachi, Pakistan
| | - Jaakko Tuomilehto
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
- Dasman Diabetes Institute, Kuwait City, Kuwait
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Abdelgadir E, Rashid F, Bashier A, Al Saeed M, Khalifa A, Alawadi F, Hassanein M. Use of flash glucose monitoring system in assessing safety of the SGLT2 inhibitors during Ramadan fasting in high risk insulin treated patients with type 2 diabetes. Diabetes Metab Syndr 2019; 13:2927-2932. [PMID: 31425958 DOI: 10.1016/j.dsx.2019.07.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The risks of hypoglycemia, dehydration and kidney injury may theoretically be aggravated by people with type 2 diabetes treated with Insulin and SGLT2 inhibitors during Ramadan. Data on safety and efficacy of SGLT2-I in people with type 2 diabetes treated with insulin is scanty. We aimed to assess the impact of SGLT2 inhibitors during Ramadan in high-risk patients with type 2 diabetes treated with insulin, on hypoglycemia, glycemic control and kidney function. METHODS This is a prospective interventional study on high-risk diabetes patients who insisted on fasting. All patients were treated with insulin ± SGLT2I. All patients received a FGMS and Ramadan focused education. All patients attended clinic before and post Ramadan where they were advised on treatment modification as well as biometric and biochemical measurements. RESULTS 95 patients enrolled in the study and 49 of them were on SGLT2i. There was a no significant change in creatinine in both groups. FGMS showed an improvement in the sensor-calculated HbA1c from 7.3 ± 1.5 to 6.8 ± 1.1 and from 8 ± 1.6 to 7.7 ± 1.5 in the SGLT2 group and the non-SGT2i groups, respectively. The hypoglycemia was predominantly reported during Ramadan between 12:00 to 18:00 h, while in pre-Ramadan readings was during 2400-0600 and 1200-1800 slots. CONCLUSIONS This is the first study that assesses the use of SGLT2i along with insulin during Ramadan, using FGMS in high-risk patients with type 2 diabetes under optimal care. There was minimal interruption of fasting, significant improvement in glycemic control, and no significant change in the kidney function after Ramadan.
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Affiliation(s)
| | - Fauzia Rashid
- Endocrine Department, Dubai Hospital, United Arab Emirates.
| | | | | | - Azza Khalifa
- Endocrine Department, Dubai Hospital, United Arab Emirates.
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Chen Z, Li G. Sodium-Glucose Co-Transporter 2 Inhibitors Compared with Sulfonylureas in Patients with Type 2 Diabetes Inadequately Controlled on Metformin: A Meta-Analysis of Randomized Controlled Trials. Clin Drug Investig 2019; 39:521-531. [PMID: 31041606 DOI: 10.1007/s40261-019-00781-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE When metformin is insufficient for patients with type 2 diabetes mellitus (T2DM), the optimal adjunctive therapy is unclear. This meta-analysis was to compare the efficacy and safety of sodium-glucose co-transporter 2 (SGLT2) inhibitors with sulfonylureas (SUs) as second-line therapy in patients with T2DM inadequately controlled on metformin. METHODS We systematically searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov for randomized controlled trials comparing SGLT2 inhibitors with SUs as add-on to metformin. Our primary endpoints were glycemic control, hypoglycemia, and change in weight. We assessed pooled data using a random-effects model. RESULTS Five trials involving 4300 participants were included in our meta-analysis. Compared with SUs, SGLT2 inhibitors led to no significant reduction in changes in HbA1c (mean difference [MD] - 0.06; 95% confidence interval [CI] [- 0.12, 0.08]), but less hypoglycemia as add-on to metformin (odds ratio [OR] 0.12; 95% CI [0.07, 0.21]). SGLT2 inhibitors led to a reduction in weight by about 3.5 kg; however, SUs caused a gain in weight by about 1 kg (MD - 4.39; 95% CI [- 4.64, - 4.14]). SGLT2 inhibitors also showed a reduction in blood pressure, but increased the incidence of genital tract infections compared with SUs. Interestingly, subgroup analysis by duration of interventions showed that reduction of HbA1c from baseline was similar between the two groups at 12-52 weeks, but SGLT2 inhibitors led to a greater reduction in HbA1c at 104-208 weeks. CONCLUSIONS Despite similar glycemic efficacy in a relatively short term, SGLT2 inhibitors are more effective in the longer term than SUs as add-on to metformin. In addition, SGLT2 inhibitors produce less hypoglycemic events and lead to greater reductions in weight and blood pressure compared with SUs.
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Affiliation(s)
- Ze Chen
- School of Medicine, Wuhan University, No. 115 Donghu Road, Wuhan, 430071, Hubei, China.
| | - Gerui Li
- School of Medicine, Wuhan University, No. 115 Donghu Road, Wuhan, 430071, Hubei, China
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Beshyah SA, Chowdhury TA, Ghouri N, Lakhdar AA. Risk of diabetic ketoacidosis during Ramadan fasting: A critical reappraisal. Diabetes Res Clin Pract 2019; 151:290-298. [PMID: 30836132 DOI: 10.1016/j.diabres.2019.02.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 02/27/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To evaluate the validity of the perceived increased risk and the actual occurrence of DKA observed during fasting in Ramadan. METHODS This is a non-systematic narrative review of the literature on the occurrence of DKA during Ramadan. Online databases (PubMed, Google Scholar, Cochrane Database, Medline OVID and CINAHL EBSCO) were searched. Three research questions are addressed 1. What is the basis of the expert opinion on the risk for DKA? 2. What is the likelihood that DKA is precipitated by Ramadan fast? and 3. What is the frequency of observed DKA during Ramadan? RESULTS The expert opinion suggesting a risk of DKA during Ramadan fasting was proposed with no evidence in the early writing on Ramadan fasting and has been reiterated and propagated since then. However, from first principles, DKA is not readily precipitated by the usual stress-free metabolic environment induced by Ramadan fasting with the exception of cases involved in the usual risk factors for metabolic decompensation. Furthermore, recent studies could not document any increase in observed DKA during Ramadan fasting in retrospective, prospective and database studies. CONCLUSIONS The current state of knowledge and evidence suggests the risk of DKA is not increased during Ramadan fasting.
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Affiliation(s)
- Salem A Beshyah
- Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Dubai Medical College, Dubai, United Arab Emirates.
| | - Tahseen A Chowdhury
- The Royal London Hospital Whitechapel, Barts Health NHS Trust, London, United Kingdom
| | - Nazim Ghouri
- Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom; Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
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Abstract
INTRODUCTION Sodium-glucose cotransporter type 2 inhibitors (SGLT2is) are recommended after metformin for a large spectrum of patients with type 2 diabetes, because of a favorable benefit/risk profile despite a variety of adverse events. AREAS COVERED This narrative review discusses the safety profile of SGLT2is: initial concerns (cardiovascular safety, acute renal failure, hypoglycemia, urinary and genital infections, volume depletion, bladder cancer), further concerns (euglycemic ketoacidosis, bone fractures) and more recent concerns (lower limb amputation, Fournier's gangrene). EXPERT OPINION Overall, the safety profile of SGLT2is is good. The only increased adverse event that was consistently reported in clinical trials and observational studies is genital mycotic infections, with only a borderline increase in urinary tract infections. Among clinical trials, only the CANVAS program reported an unexpected increase in bone fractures and peripheral amputations. A variety of rare adverse events have been described as case reports, including ketoacidosis, amputations and Fournier gangrene, which led to specific warnings by regulatory agencies. Identifying predisposing patient's characteristics and/or precipitating clinical conditions would help prevent the most severe complications. These adverse events should not mask the overall cardiovascular and renal benefit of SGLT2is, especially in patients with type 2 diabetes at high cardiovascular risk.
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Affiliation(s)
- André J Scheen
- a Division of Clinical Pharmacology , Center for Interdisciplinary Research on Medicines (CIRM), Liège University , Liège , Belgium.,b Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine , CHU Liège , Liège , Belgium
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Rashid F, Abdelgadir E. A systematic review on efficacy and safety of the current hypoglycemic agents in patients with diabetes during Ramadan fasting. Diabetes Metab Syndr 2019; 13:1413-1429. [PMID: 31336501 DOI: 10.1016/j.dsx.2019.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 02/01/2019] [Indexed: 01/18/2023]
Abstract
The fasting in the holy month of Ramadan is passionately practised among the Muslims population around the world. Patients with diabetes are generally considered to have various risks with fasting. The recent pharmacologic and technical advances in the management of diabetes may have enabled these patients to practice safe fasting. The purpose of this review is to scientific evidence on the safety and efficacy of the current hypoglycemic agents during Ramadan. METHODS: An extensive Electronic search via PubMed and Google scholar was accomplished through using different search terms. The eligible studies were limited to only published Randomised controlled trial (RCT) and prospective observational studies from 2007 to 2018 on patients with all types of diabetes on any pharmacological management, who intended to fast in Ramadan. RESULTS AND CONCLUSIONS: The current era witnessed a gradual shift in the management of these patients with diabetes who elected to fast in Ramadan, despite the variable health-related risks with fasting. Results from available RCTs and observational studies in patients with type 2 diabetes showed lower risk of hypoglycemia, similar or better efficacy for glycemic and weight control with SGLT2 inhibitors, incretin mimetics and the newer insulin analogues compared to Sulfonylurea. Gliclazide is a relatively safer option among all sulfonylurea. Patients requiring insulin did better with insulin analogues, especially the newer premixed formulation at the time of breaking fast compared to the former insulin formulation. Current commonly used newer hypoglycemic agents are generally safe during Ramadan, however, their safety in the higher risk diabetes patients is highly needed.
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Affiliation(s)
- Fauzia Rashid
- Endocrine Department, Dubai Hospital, P.O.Box: 7272, Dubai, United Arab Emirates
| | - Elamin Abdelgadir
- Endocrine Department, Dubai Hospital, P.O.Box: 7272, Dubai, United Arab Emirates.
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Bajaj HS, Abouhassan T, Ahsan MR, Arnaout A, Hassanein M, Houlden RL, Khan T, Khandwala H, Verma S. Diabetes Canada Position Statement for People With Types 1 and 2 Diabetes Who Fast During Ramadan. Can J Diabetes 2019; 43:3-12. [DOI: 10.1016/j.jcjd.2018.04.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Donnan JR, Grandy CA, Chibrikov E, Marra CA, Aubrey-Bassler K, Johnston K, Swab M, Hache J, Curnew D, Nguyen H, Gamble JM. Comparative safety of the sodium glucose co-transporter 2 (SGLT2) inhibitors: a systematic review and meta-analysis. BMJ Open 2019; 9:e022577. [PMID: 30813108 PMCID: PMC6361337 DOI: 10.1136/bmjopen-2018-022577] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/14/2018] [Accepted: 11/02/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To estimate the association between the use of sodium glucose co-transporter-2 (SGLT2) inhibitors and postmarket harms as identified by drug regulatory agencies. DESIGN We conducted a systematic review and meta-analysis of randomised controlled trials (RCT). Six large databases were searched from inception to May 2018. Random effects models were used to estimate pooled relative risks (RRs). INTERVENTION SGLT2 inhibitors, compared with placebo or active comparators. PRIMARY OUTCOMES Acute kidney injury (AKI), diabetic ketoacidosis (DKA), urinary tract infections (UTI), bone fractures and lower limb amputations. RESULTS We screened 2418 citations of which 109 were included. Most studies included one of four SGLT2 inhibitors, dapagliflozin, canagliflozin, empagliflozin and ipragliflozin. When compared with placebo, SGLT2 inhibitors were found to be significantly protective against AKI (RR=0.59; 95% CI 0.39 to 0.89; I2=0.0%), while no difference was found for DKA (RR 0.66; 95% CI 0.30 to 1.45, I2=0.0%), UTI (RR 1.02; 95% CI 0.95 to 1.09, I2=0.0%) or bone fracture (RR 0.87; 95% CI 0.69 to 1.09, I2=1.3%). Three studies reported on amputation, with one finding a significant increase risk. No increased risk for either outcome was found when compared with active controls. Subgroup analysis did show an increased risk of UTI with dapagliflozin only (RR 1.21; 95% CI 1.02 to 1.43, I2=0.0%), but no other analysis supported an increased risk of AKI, DKA, UTI or fracture. CONCLUSIONS Current evidence from RCTs does not suggest an increased risk of harm with SGLT2 inhibitors as a class over placebo or active comparators with respect to AKI, DKA, UTI or fracture. However, wide CIs for many comparisons suggest limited precision, and therefore clinically important adverse events cannot be ruled out. Dapagliflozin, appears to independently increase the risk of UTI, although the mechanism for this intraclass variation in risk is unclear. PROSPERO REGISTRATION NUMBER CRD42016038715.
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Affiliation(s)
- Jennifer R Donnan
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Catherine A Grandy
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Eugene Chibrikov
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Carlo A Marra
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Kris Aubrey-Bassler
- Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Karissa Johnston
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Michelle Swab
- Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Jenna Hache
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Daniel Curnew
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Hai Nguyen
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - John-Michael Gamble
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
- School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, Ontario, Canada
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Elhadd T, Dabbous Z, Bashir M, Elzouki A, Ghadban W, Baagar K, Benjamin S, Hassanien M, Saeed AAM, Dukhan K, Malik RA, Abou-Samra AB. Incidence of hypoglycaemia in patients with type-2 diabetes taking multiple glucose lowering therapies during Ramadan: the PROFAST Ramadan Study. J Diabetes Metab Disord 2018; 17:309-314. [PMID: 30918866 DOI: 10.1007/s40200-018-0374-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/09/2018] [Indexed: 11/26/2022]
Abstract
Objective To assess the incidence of hypoglycemia in people with type-2 diabetes mellitus (T2DM) on three or more anti-diabetic medications during Ramadan. Study design methods We have studied people with T2DM on three or more glucose-lowering drugs during Ramadan of H1438 (May-June 2017). The dose of each drug was adjusted according to a pre-specified protocol. The incidence of symptomatic or blood glucose confirmed hypoglycemia was recorded during the study. Results We enrolled 228 people with T2DM; 181 completed the study, and data on hypoglycaemia was available in 172 subjects. There were 115 males and 66 females, (mean age ± SD) 53.6 ± 9.7 years, diabetes duration 10 ± 6 yrs. The incidence of hypoglycaemia was 16.3% (28/172). Univariable logistic regression analysis showed that the risk of hypoglycaemia was increased in Arab subjects compared to Qatari; in those with longer duration of diabetes; and in those on four or more anti-diabetic medications compared to those on three anti-diabetic medications. Conclusion Despite the tailored advice, there is a high incidence of hypoglycemia in people with T2DM taking multiple glucose lowering therapies whilst fasting during Ramadan. Guidelines should address the increased complexity in anti-diabetic medications in patients who fast during Ramadan. Healthcare providers should individualize the modifications in anti-diabetic medications during Ramadan.
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Affiliation(s)
- Tarik Elhadd
- 1Qatar Metabolic Institute, Department of Medicine, Hamad Medical Corporation, Modular Building, Doha, Qatar
| | - Zeinab Dabbous
- 1Qatar Metabolic Institute, Department of Medicine, Hamad Medical Corporation, Modular Building, Doha, Qatar
| | - Mohammed Bashir
- 1Qatar Metabolic Institute, Department of Medicine, Hamad Medical Corporation, Modular Building, Doha, Qatar
| | - Abdulnasir Elzouki
- 1Qatar Metabolic Institute, Department of Medicine, Hamad Medical Corporation, Modular Building, Doha, Qatar
| | - Wissam Ghadban
- 1Qatar Metabolic Institute, Department of Medicine, Hamad Medical Corporation, Modular Building, Doha, Qatar
| | - Khaled Baagar
- 1Qatar Metabolic Institute, Department of Medicine, Hamad Medical Corporation, Modular Building, Doha, Qatar
| | - Silas Benjamin
- 1Qatar Metabolic Institute, Department of Medicine, Hamad Medical Corporation, Modular Building, Doha, Qatar
| | | | - Abazar A M Saeed
- 1Qatar Metabolic Institute, Department of Medicine, Hamad Medical Corporation, Modular Building, Doha, Qatar
| | - Khaled Dukhan
- 1Qatar Metabolic Institute, Department of Medicine, Hamad Medical Corporation, Modular Building, Doha, Qatar
| | | | - Abdul-Badie Abou-Samra
- 1Qatar Metabolic Institute, Department of Medicine, Hamad Medical Corporation, Modular Building, Doha, Qatar
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Lee SWH, Lai NM, Chen WS, Sellappans R. Interventions for people with type 2 diabetes mellitus fasting during Ramadan. Hippokratia 2018. [DOI: 10.1002/14651858.cd013178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Shaun Wen Huey Lee
- Monash University Malaysia; School of Pharmacy; Bandar Sunway Malaysia 47500
| | - Nai Ming Lai
- Taylor's University; School of Medicine; Subang Jaya Malaysia
| | - Won Sun Chen
- Swinburne University of Technology; Department of Statistics, Data Science and Epidemiology; John Street Hawthorn Victoria Australia 3122
| | - Renukha Sellappans
- Faculty of Health and Medical Sciences, Taylor’s University; School of Pharmacy; 1, Jalan Taylor’s Subang Jaya Selangor Malaysia 47500
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Unnikrishnan AG, Kalra S, Purandare V, Vasnawala H. Genital Infections with Sodium Glucose Cotransporter-2 Inhibitors: Occurrence and Management in Patients with Type 2 Diabetes Mellitus. Indian J Endocrinol Metab 2018; 22:837-842. [PMID: 30766827 PMCID: PMC6330876 DOI: 10.4103/ijem.ijem_159_17] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Diabetes is a metabolic disorder characterized by hyperglycemia and is associated with several comorbidities and complications. Genital infection is one such complication that is often associated with diabetes mellitus (DM). Even though abnormalities in immune system, high urine glucose, and bladder dysfunction are important contributors for the increased risk of genitourinary symptoms, yet the possible role of pharmacologically induced glucosuria cannot be completely overlooked in such patients. There are various classes of medications to control blood glucose levels. A new therapeutic option to manage hyperglycemia is to increase renal glucose excretion by inhibiting sodium-glucose cotransporter-2 (SGLT2) glucose transport proteins. SGLT2 inhibitors (SGLT2i) represent a novel class of oral antidiabetic drugs which are associated with drug-induced glucosuria. Currently, canagliflozin, dapagliflozin, and empagliflozin are the three SGLT2i approved for therapy in Type 2 DM (T2DM). Safety studies with these three SGLT2i have reported events of mild-moderate genital infections in patients on SGLT2i therapy. However, most of the reported infections responded to standard treatment. Apart from SGLT2i, factors including personal hygiene, menopause, and circumcision might have a possible role in reported events of genital infections among T2DM patients on SGLT2i therapy. The present review identifies the occurrence of genital infections in diabetic patients on SGLT2i therapy, factors affecting the incidence of genital infections, and management strategies in patients with T2DM on SGLT2i therapy.
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Affiliation(s)
- A. G. Unnikrishnan
- Department of Endocrinology, Chellaram Diabetes Institute, Pune, Maharashtra, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Research Institute of Diabetes, Bharti Hospital, Karnal, Haryana, India
| | - Vedavati Purandare
- Department of Endocrinology, Chellaram Diabetes Institute, Pune, Maharashtra, India
| | - Hardik Vasnawala
- Medical Affairs, AstraZeneca Pharma India Ltd., Bengaluru, Karnataka, India
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Shao Y, Lim GJ, Chua CL, Wong YF, Yeoh ECK, Low SKM, Sum CF. The effect of Ramadan fasting and continuing sodium-glucose co-transporter-2 (SGLT2) inhibitor use on ketonemia, blood pressure and renal function in Muslim patients with type 2 diabetes. Diabetes Res Clin Pract 2018; 142:85-91. [PMID: 29802956 DOI: 10.1016/j.diabres.2018.05.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/28/2018] [Accepted: 05/11/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The effect of Ramadan fasting and continuing sodium-glucose co-transporter-2 (SGLT2) inhibitor use on ketonemia, blood pressure and renal function in Muslim patients with type 2 diabetes. METHODS This is a single-centre prospective observational controlled cohort study. Muslim patients aged 21-75 years with type 2 diabetes and estimated glomerular filtration rate (eGFR) ≥ 45 ml/min/1.73 m2 were eligible if they had no contraindication to observe Ramadan fasting. Patients in study group were on stable dose of SGLT2 inhibitor for at least 3 months before enrolment and continued during study period, while patients in control group were not on SGLT2 inhibitor before and during study period. All participants attended baseline visit before Ramadan and follow-up visit during Ramadan. RESULTS A total of 68 patients of similar baseline characteristics were included in the study: 35 in study group and 33 in control group. During Ramadan fasting, patients from study and control group had similar change in weight (LS mean change of -1.8 versus -1.1 kg, p = 0.205), eGFR (LS mean change of -6.0 versus -4.2 ml/min/1.73 m2, p = 0.399), sitting systolic BP (LS mean change of -8.1 versus -10.4 mmHg, p = 0.569), sitting diastolic BP (LS mean change of -3.7 versus -3.5 mmHg, p = 0.934) and plasma β-hydroxybutyrate level (LS mean change of -0.01 versus -0.02 mmol/L, p = 0.649). CONCLUSIONS Ramadan fasting was associated with significant changes in weight, BP and eGFR regardless whether patients were on SGLT2 inhibitor treatment. Continued use of SGLT2 Inhibitors during Ramadan did not increase ketonemia, nor increase risk of eGFR deterioration and hypoglycaemia.
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Affiliation(s)
- Yanli Shao
- Diabetes Centre, Admiralty Medical Centre (Khoo Teck Puat Hospital), Level 4, Kampung Admiralty, Blk 676, Woodlands Drive 71, S730676, Singapore.
| | - Gwyneth Joy Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Chin Lian Chua
- Diabetes Centre, Admiralty Medical Centre and Khoo Teck Puat Hospital, Singapore
| | - Yip Fong Wong
- Diabetes Centre, Admiralty Medical Centre and Khoo Teck Puat Hospital, Singapore
| | | | | | - Chee Fang Sum
- Diabetes Centre, Admiralty Medical Centre and Khoo Teck Puat Hospital, Singapore
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Bashier A, Khalifa AA, Abdelgadir EI, Al Saeed MA, Al Qaysi AA, Bayati MBA, Alemadi B, Bachet F, Alawadi F, Hassanein M. Safety of Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2-I) During the Month of Ramadan in Muslim Patients with Type 2 Diabetes. Oman Med J 2018; 33:104-110. [PMID: 29657678 DOI: 10.5001/omj.2018.21] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives Sodium-glucose cotransporter 2 inhibitors (SGLT2-I) are a new class of antidiabetic drugs that might increase the risk of dehydration and hypoglycemia, particularly during the month of Ramadan in which Muslims abstain from eating and drinking for 14-16 hours daily. We aimed to provide real-life evidence about the safety of SGLT2-I during Ramadan. Methods All patients over the age of 18 years on SGLT2-I before Ramadan 2016 who would be fasting during Ramadan were included. Demographic data, detailed medical history including comorbidities and medication profile, and laboratory results were collected before and after Ramadan. We also conducted a phone interview to evaluate the frequency and severity of hypoglycemia and dehydration. Results Of the total of 417 patients, 113 (27.0%) experienced hypoglycemic events, and 93 of these (82.3%) checked their blood glucose using a glucometer. Confirmed hypoglycemia (< 70 mg/dL) was observed in 78 (83.8%). The hypoglycemic events were significantly more frequent in the SGLT2-I plus insulin-treated group than in those treated with SGLT2-I plus oral hypoglycemic agents group (p < 0.001). Confirmed hypoglycemic events were more frequent in those using SGLT2-I plus intensive insulin compared to those using SGLT2-I plus basal insulin (p = 0.020). Symptoms of dehydration were seen in 9.3% (n = 39) of the total population. We observed statistically significant reductions in glycated hemoglobin and weight by the end of Ramadan (p < 0.001). There were no significant changes in lipid profile and creatinine levels by the end of the study. Conclusions The use of insulin in combination with SGLT2-I increases the risk of hypoglycemia during Ramadan. Hypoglycemic events were mild and did not require hospital admission. However, careful monitoring during prolonged fasting is warranted. No significant harmful effects on renal function result from treatment with SGLT2-I during Ramadan.
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Affiliation(s)
| | | | | | | | | | | | | | - Fawzi Bachet
- Endocrine Department, Dubai Hospital, Dubai, UAE
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Li J, Shao YH, Wang XG, Gong Y, Li C, Lu Y. Efficacy and safety of sodium-glucose cotransporter 2 inhibitors as add-on to metformin and sulfonylurea treatment for the management of type 2 diabetes: a meta-analysis. Endocr J 2018; 65:335-344. [PMID: 29375082 DOI: 10.1507/endocrj.ej17-0372] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study evaluates the efficacy and safety of sodium-glucose cotransporter 2 (SGLT2) inhibitors as add-on to metformin and sulfonylurea treatment for type 2 diabetes management. The literature search was conducted in electronic databases and meta-analyses of mean differences in the changes from baseline in selected disease endpoints (efficacy endpoints) or odds ratios (for safety endpoints) were performed to compare outcomes between SGLT2 inhibitor- and placebo-/comparator-treatments. Seven studies (5,143 patients; age 56.75 years [95% CI: 56.19, 57.37]; body mass index 29.53 kg/m2 [28.23, 30.83]; and 51.87% [50.46, 53.57] males) were included. Compared to placebo, SGLT2 inhibitors significantly (p < 0.00001) reduced glycated hemoglobin (HbA1c; -0.79% [95% CI: -0.90, -0.68]), fasting plasma glucose (FPG; -1.73 mmol/L [-1.86, -1.60]) and body weight (-1.85 kg [-2.11, -1.59]) after 52-78 weeks of treatment. There were no significant differences in reduction of either HbA1c, FPG or body weight between 18-24 weeks and after 52-76 weeks of treatment. Treatment with SGLT2 inhibitors as add-on to metformin and sulfonylurea was also associated with significant reductions in blood pressure and triglycerides and increase in high-density lipoprotein-cholesterol. Incidence of hypoglycemia was significantly higher, but incidence of hyperglycemia was significantly lower in SGLT2 inhibitor group. Overall, drug-related adverse events were more common in SGLT2 group mainly due to higher incidence of genital tract infections.
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Affiliation(s)
- Jian Li
- Department of Geriatric Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
| | - Ying-Hong Shao
- Outpatient Department, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiao-Gang Wang
- Department of Neurosurgery, Institute of Neurology, General Hospital of Shenyang Military Area Command, Shenyang, Liaoning 110840, China
| | - Yanping Gong
- Department of Geriatric Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
| | - Chunlin Li
- Department of Geriatric Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
| | - Yanhui Lu
- Department of Geriatric Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
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Adnan Z. Risk stratification of patients with diabetes and the role of sodium glucose co-transporter inhibitors 2 during Ramadan fasting. Diabetes Res Clin Pract 2017; 131:217-218. [PMID: 28778048 DOI: 10.1016/j.diabres.2017.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/07/2017] [Accepted: 07/07/2017] [Indexed: 02/02/2023]
Abstract
The month of Ramadan represents a golden opportunity for better management of patients with diabetes not only during Ramadan month, but also through the entire year. Pre Ramadan period is crucial for evaluating and preparing patients with diabetes intending to Fast Ramadan. The risk stratification categories should take into consideration patients with diabetes having specific conditions such as nephrotic syndrome who are predisposed to thrombosis independent to their estimated glomerular filtration rate and glycated haemoglobin. Furthermore, population-specific conditions such as nomadic Bedouins living in remote areas should be considered as part of the very high risk category for fasting Ramadan. Published data regarding the use of sodium glucose co-transporter 2 inhibitors during Ramadan is very limited. Dapagliflozin was the only agent studied during Ramadan. Therefore, it is suggested to categorize this group of agents differently from other agents such as metformin and incretin based therapy studied vastly during Ramadan.
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Affiliation(s)
- Zaina Adnan
- Internal Medicine, Endocrinology, Diabetes and Metabolism, Clalit Medical Services, Israel.
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Hassanein M, Al-Arouj M, Hamdy O, Bebakar WMW, Jabbar A, Al-Madani A, Hanif W, Lessan N, Basit A, Tayeb K, Omar M, Abdallah K, Al Twaim A, Buyukbese MA, El-Sayed AA, Ben-Nakhi A. Diabetes and Ramadan: Practical guidelines. Diabetes Res Clin Pract 2017; 126:303-316. [PMID: 28347497 DOI: 10.1016/j.diabres.2017.03.003] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/06/2017] [Indexed: 12/24/2022]
Abstract
Ramadan fasting is one of the five pillars of Islam and is compulsory for all healthy Muslims from puberty onwards. Exemptions exist for people with serious medical conditions, including many with diabetes, but a large number will participate, often against medical advice. Ensuring the optimal care of these patients during Ramadan is crucial. The International Diabetes Federation (IDF) and Diabetes and Ramadan (DAR) International Alliance have come together to deliver comprehensive guidelines on this subject. The key areas covered include epidemiology, the physiology of fasting, risk stratification, nutrition advice and medication adjustment. The IDF-DAR Practical Guidelines should enhance knowledge surrounding the issue of diabetes and Ramadan fasting, thereby empowering healthcare professionals to give the most up-to-date advice and the best possible support to their patients during Ramadan.
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Affiliation(s)
- Mohamed Hassanein
- Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
| | | | | | - Wan Mohamad Wan Bebakar
- School of Medical Sciences, Universiti Sains Malaysia, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia
| | | | | | - Wasim Hanif
- University Hospital Birmingham, Birmingham, UK
| | - Nader Lessan
- Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates
| | - Abdul Basit
- Baqai Institute of Diabetology & Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Khaled Tayeb
- Diabetes Center, Al-Noor Hospital, Makkah, Saudi Arabia
| | - Mak Omar
- Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa
| | | | - Abdulaziz Al Twaim
- King Abdulaziz Medical City, National Guard Hospital, Western Region, Saudi Arabia
| | | | - Adel A El-Sayed
- Chair of Diabetes Unit, Department of Internal Medicine, Sohag Faculty of Medicine, Sohag University, Egypt
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Lim LL, Tan ATB, Moses K, Rajadhyaksha V, Chan SP. Place of sodium-glucose cotransporter-2 inhibitors in East Asian subjects with type 2 diabetes mellitus: Insights into the management of Asian phenotype. J Diabetes Complications 2017; 31:494-503. [PMID: 27866701 DOI: 10.1016/j.jdiacomp.2016.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/26/2016] [Accepted: 10/12/2016] [Indexed: 12/22/2022]
Abstract
The burden of type 2 diabetes (T2DM) in East Asia is alarming. Rapid modernization and urbanization have led to major lifestyle changes and a tremendous increase in the prevalence of obesity, metabolic syndrome, and diabetes mellitus. The development of T2DM at a younger age, with lower body mass index, higher visceral adiposity, and more significant pancreatic beta-cell dysfunction compared to Caucasians are factors responsible for the increased prevalence of T2DM in East Asians. Sodium-glucose Cotransporter-2 (SGLT2) inhibitors (canagliflozin, dapaglifozin, empagliflozin, etc.) reduce renal glucose reabsorption, leading to favorable effects on glycemic, blood pressure, and weight control. The insulin-independent mechanism enables their use as monotherapy or combination therapy with insulin and other oral antidiabetic agents. The role of SGLT2 inhibitors in the management of T2DM among East Asians is an interesting area of research, given that East Asians have been proven to be uniquely different from Caucasians. This review provides comprehensive coverage of the available literature not only on the efficacy and safety, but also on the recent cardiovascular and renal outcomes of SGLT2 inhibitors, focusing among East Asians.
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Affiliation(s)
- Lee Ling Lim
- Division of Endocrinology, Department of Internal Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Alexander Tong Boon Tan
- Division of Endocrinology, Department of Internal Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - Siew Pheng Chan
- Division of Endocrinology, Department of Internal Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Kalra S, Ghosh S, Aamir AH, Ahmed MT, Amin MF, Bajaj S, Baruah MP, Bulugahapitiya U, Das AK, Giri M, Gunatilake S, Mahar SA, Pathan MF, Qureshi NK, Raza SA, Sahay R, Shakya S, Shreshta D, Somasundaram N, Sumanatilleke M, Unnikrishnan AG, Wijesinghe AM. Safe and pragmatic use of sodium-glucose co-transporter 2 inhibitors in type 2 diabetes mellitus: South Asian Federation of Endocrine Societies consensus statement. Indian J Endocrinol Metab 2017; 21:210-230. [PMID: 28217523 PMCID: PMC5240067 DOI: 10.4103/2230-8210.196029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
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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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - Sujoy Ghosh
- Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - A. H. Aamir
- Department of Endocrinology and Metabolic Diseases, Post Graduate Medical Institute, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Md. Tofail Ahmed
- Department of Endocrinology, BIRDEM and Ibrahim Medical College, Dhaka, Bangladesh
| | - Mohammod Feroz Amin
- Department of Endocrinology, BIRDEM and Ibrahim Medical College, Dhaka, Bangladesh
| | - Sarita Bajaj
- Department of Medicine, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - Manash P. Baruah
- Department of Endocrinology, Excel Centre Hospitals, Guwahati, Assam, India
| | | | - A. K. Das
- Department of Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Mimi Giri
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sonali Gunatilake
- Department of Endocrinology, Colombo South Teaching Hospital, Colombo, Sri Lanka
| | - Saeed A. Mahar
- Department of Medicine, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Md. Faruque Pathan
- Department of Endocrinology, BIRDEM and Ibrahim Medical College, Dhaka, Bangladesh
| | | | - S. Abbas Raza
- Department of Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, Telangana, India
| | - Santosh Shakya
- Diabetes, Thyroid and Endocrinology Care Centre, Kopundole, Nepal
| | - Dina Shreshta
- Department of Endocrinology, Norvic Hospital, Kathmandu, Nepal
| | - Noel Somasundaram
- Department of Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | | - A. G. Unnikrishnan
- Department of Endocrinology, Chellaram Institute of Diabetes, Pune, Maharashtra, India
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John M, Cerdas S, Violante R, Deerochanawong C, Hassanein M, Slee A, Canovatchel W, Hamilton G. Efficacy and safety of canagliflozin in patients with type 2 diabetes mellitus living in hot climates. Int J Clin Pract 2016; 70:775-85. [PMID: 27600862 PMCID: PMC5129493 DOI: 10.1111/ijcp.12868] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/11/2016] [Indexed: 12/19/2022] Open
Abstract
AIMS Patients with type 2 diabetes mellitus (T2DM) have increased risk of adverse events (AEs; e.g. dehydration, hypoglycaemia) in hot weather. This analysis assessed the efficacy and safety of canagliflozin, a sodium glucose co-transporter 2 (SGLT2) inhibitor, in patients with T2DM who live in hot climates. METHODS This post hoc analysis evaluated patients with T2DM using pooled data from four 26-week, placebo-controlled studies (N=2,313) and data from a 104-week, active-controlled study (add-on to metformin vs glimepiride; N=1,450). Changes in HbA1c, fasting plasma glucose (FPG), body weight and blood pressure (BP) were assessed in subsets of patients living in hot climates (pooled, placebo-controlled studies, n=611; active-controlled study, n=307) and those living in other climates (i.e. other climate subset; pooled, placebo-controlled studies, n=1,702; active-controlled study, n=1,143). Safety was assessed based on AE reports. RESULTS Canagliflozin 100 and 300 mg lowered HbA1c, FPG, body weight and BP vs placebo over 26 weeks and glimepiride over 104 weeks in the hot climate subsets. Canagliflozin was generally well tolerated in the hot climate subsets, with a higher incidence of AEs related to the mechanism of SGLT2 inhibition (i.e. genital mycotic infections). Volume depletion-related AEs were low across groups. CONCLUSION Canagliflozin improved glycaemic control, lowered body weight and BP, and was generally well tolerated in patients with T2DM living in hot climates compared with placebo over 26 weeks or glimepiride over 104 weeks. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov NCT01081834, NCT01106677, NCT01106625, NCT01106690, NCT00968812.
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Affiliation(s)
- Mathew John
- Providence Endocrine & Diabetes Specialty Centre, Trivandrum, Kerala, India.
| | - Sonia Cerdas
- Hospital Cima, Centro de Investigacíon Clínica San Agustín, San José, Costa Rica
| | - Rafael Violante
- Centro de Estudios de Investigacíon Metabólicos y Cardiovasculares S.C., Tampico, Mexico
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