Endocrinol Metab.  2017 Jun;32(2):265-273. 10.3803/EnM.2017.32.2.265.

Predetermined Anti-Diabetic Drug Regimen Adjustments during Ramadan Fasting: An Observational Study of Safety

• Beano AM
• Zmaili MA
• Gheith ZH
• Naser AM
• Momani MS
• Yousef AM
• Zayed AA

• KMID: 2384086
• DOI: http://doi.org/10.3803/EnM.2017.32.2.265

Abstract

BACKGROUND
Many Muslim type 2 diabetes mellitus (T2DM) patients choose to fast the month of Ramadan despite the possible adverse health effects brought about by the change in dietary habits, among other things. Clinical data regarding the safety of multi-drug regimens during fasting are particularly scarce. The aim of the study was to evaluate the safety of a drug protocol devised by the authors to accommodate Ramadan's dietary changes, involving dose adjustments of four anti-diabetic drug regimens in T2DM patients fasting Ramadan.
METHODS
In this prospective, observational, open-label study, 301 T2DM patients who wished to fast Ramadan were followed during Ramadan and the preceding month. The incidence of hypoglycemia, diabetic ketoacidosis (DKA) and non-ketotic hyperosmolar state (NKHS) was monitored. Patients were classified into four groups: A group (those taking metformin, sulfonylurea and insulin [n=33]); B group (metformin and sulfonylurea [n=89]); C group (metformin and insulin [n=96]); and D group (premixed 70/30, glargine or regular insulin [n=82]). During Ramadan, drug doses were adjusted as percentages of their pre-Ramadan values: 75% for sulfonylureas, 75% for glargine, 75% for premixed insulin 70/30 in two doses, and 75% for regular insulin. Metformin was adjusted to a twice-daily regimen.
RESULTS
No cases of DKA or NKHS were reported. Hypoglycemia occurred at a lower rate than pre-Ramadan values in groups C, and D; and a similar rate in groups A, and B.
CONCLUSION
The data suggested that using the above protocol to adjust the doses of anti-diabetic drugs is safe in T2DM patients in regards to hypoglycemia, DKA, and NKHS.

Keyword

Ramadan; Hypoglycemia; Sulfonylurea; Metformin; Insulin

MeSH Terms

Diabetes Mellitus, Type 2
Diabetic Ketoacidosis
Fasting*
Food Habits
Humans
Hypoglycemia
Incidence
Insulin
Insulin Glargine
Islam
Metformin
Observational Study*
Prospective Studies
Insulin
Insulin Glargine
Metformin

Figure

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  Fig. 1 The number of enrolled subjects included and excluded from the data analysis.

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  Fig. 2 The prevalence of hypoglycemic episodes in each drug group before and during Ramadan. Group A (patients on metformin, glimepiride and insulin), B (patients on metformin and glimepiride), C (patients on metformin and insulin), and D (patients on insulin alone).

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