Diabetes and Ramadan: An Update On Use of Glycemic Therapies During Fasting

Abstract

The fasting of Ramadan is observed by a large proportion of Muslims with diabetes. Recommendations for the management of diabetes during Ramadan were last published in 2005 by the American Diabetes Association. Several studies in this field have since been published, some addressing the use of new pharmacological agents in managing diabetes during Ramadan. The incritin memetics are potentially safe during Ramadan; the DPP4 inhibitors vildagliptin and sitagliptin provide an effective and safe therapeutic option, administered either alone or in combination with metformin or sulfonylureas. There are no published studies on the use of GLP-1 receptor agonists during Ramadan. Among the sulfonylureas, gliclazide MR (modified release) and glimepride can be safely used during Ramadan, but glibenclamide should be avoided due to the associated risk of hypoglycemia. In selected patients with type 1 and type 2 diabetes, the long-acting insulin analogues glargine and detemir, as well as the premixed insulin analogues, can be used with minimal risk of metabolic derangement or hypoglycemia; the risk is higher in type 1 diabetes. Insulin pumps can potentially empower patients with diabetes and enable safe fasting during the month of Ramadan. Further clinical trials are needed to evaluate the safety and efficacy of new antidiabetic agents and new diabetes-related technologies during Ramadan.

The effect of vildagliptin relative to sulphonylureas in Muslim patients with type 2 diabetes fasting during Ramadan: the VIRTUE study

“…This positive result is noteworthy in that it was achieved without episodes of severe hypoglycaemia in the vildagliptin cohort, and is consistent with findings from previous vildagliptin research undertaken in this patient population ( 11 , 12 ). Related to this end-point, a descriptive analysis assessing the usage of individual SUs and the frequency of HEs with these SUs is particularly interesting; the data suggest a preference for the use of glimepiride and gliclazide (approximately three quarters of the latter appeared to receive the modified release formulation of gliclazide), as opposed to glibenclamide, presumably as a consequence of the higher incidence of HEs reported previously with glibenclamide ( 13 – 15 ). Reassuringly, vildagliptin appeared to be associated with a lower incidence of HEs regardless of the individual SU employed; it is not immediately apparent as to why this consistent effect was not observed in studies with other DPP-4 inhibitors ( 14 , 16 ).…”

The effect of vildagliptin relative to sulphonylureas in Muslim patients with type 2 diabetes fasting during Ramadan: the VIRTUE study

“…This positive result is noteworthy in that it was achieved without episodes of severe hypoglycaemia in the vildagliptin cohort, and is consistent with findings from previous vildagliptin research undertaken in this patient population ( 11 , 12 ). Related to this end-point, a descriptive analysis assessing the usage of individual SUs and the frequency of HEs with these SUs is particularly interesting; the data suggest a preference for the use of glimepiride and gliclazide (approximately three quarters of the latter appeared to receive the modified release formulation of gliclazide), as opposed to glibenclamide, presumably as a consequence of the higher incidence of HEs reported previously with glibenclamide ( 13 – 15 ). Reassuringly, vildagliptin appeared to be associated with a lower incidence of HEs regardless of the individual SU employed; it is not immediately apparent as to why this consistent effect was not observed in studies with other DPP-4 inhibitors ( 14 , 16 ).…”

Safety of high-risk diabetic patients during Ramadan at a tertiary care hospital in Pakistan, practicing updated IDF DAR guidelines

“…Human insulin 70/30 use in patients with Type-2 diabetes in Ramadan when compared with insulin lispro Mix25 resulted in better glucose control before and after Iftar with less glycemic variations. 18 The long acting basal analogue insulin works better by having flat curve and less chances of hypoglycemia for obvious reasons. Glargine has been studied to be safe and effective and results in less glycemic variations alone or in combination with other medications.…”

Prise en charge des patients diabétiques au cours du jeun du Ramadan: application des recommandations internationales en pratique clinique

“…Poids et apport calorique: nous remarquons l’absence d’effet significatif du jeûne du mois de Ramadan sur le poids, avec un faible taux d’écart diététique comparé à d’autres études [ 6 , 12 ]. Plusieurs études ont noté l’absence d’effet significatif du jeûne sur le poids [ 14 , 16 ].…”

“…Ce qui est en accord avec plusieurs études [ 8 , 9 , 11 ] rapportant que le jeûnee du Ramadan ne s’est pas accompagné de modifications du taux d’HbA1c, ceci est d’autant plus marqué si les patients sont préparés au jeûne. Toutefois, certaines études [ 6 , 8 , 14 , 23 , 26 ] ont montré une baisse des taux de fructosamine et d’HbA1c après le jeûnee. Une étude a noté une augmentation de l’HBA1C expliquée par la mauvaise observance du traitement [ 25 ].…”

The effect of vildagliptin relative to sulphonylureas in Muslim patients with type 2 diabetes fasting during Ramadan: the VIRTUE study

“…This positive result is noteworthy in that it was achieved without episodes of severe hypoglycaemia in the vildagliptin cohort, and is consistent with findings from previous vildagliptin research undertaken in this patient population ( 11 , 12 ). Related to this end-point, a descriptive analysis assessing the usage of individual SUs and the frequency of HEs with these SUs is particularly interesting; the data suggest a preference for the use of glimepiride and gliclazide (approximately three quarters of the latter appeared to receive the modified release formulation of gliclazide), as opposed to glibenclamide, presumably as a consequence of the higher incidence of HEs reported previously with glibenclamide ( 13 – 15 ). Reassuringly, vildagliptin appeared to be associated with a lower incidence of HEs regardless of the individual SU employed; it is not immediately apparent as to why this consistent effect was not observed in studies with other DPP-4 inhibitors ( 14 , 16 ).…”

Safety of high-risk diabetic patients during Ramadan at a tertiary care hospital in Pakistan, practicing updated IDF DAR guidelines

“…Human insulin 70/30 use in patients with Type-2 diabetes in Ramadan when compared with insulin lispro Mix25 resulted in better glucose control before and after Iftar with less glycemic variations. 18 The long acting basal analogue insulin works better by having flat curve and less chances of hypoglycemia for obvious reasons. Glargine has been studied to be safe and effective and results in less glycemic variations alone or in combination with other medications.…”

Prise en charge des patients diabétiques au cours du jeun du Ramadan: application des recommandations internationales en pratique clinique

“…Poids et apport calorique: nous remarquons l’absence d’effet significatif du jeûne du mois de Ramadan sur le poids, avec un faible taux d’écart diététique comparé à d’autres études [ 6 , 12 ]. Plusieurs études ont noté l’absence d’effet significatif du jeûne sur le poids [ 14 , 16 ].…”

“…Ce qui est en accord avec plusieurs études [ 8 , 9 , 11 ] rapportant que le jeûnee du Ramadan ne s’est pas accompagné de modifications du taux d’HbA1c, ceci est d’autant plus marqué si les patients sont préparés au jeûne. Toutefois, certaines études [ 6 , 8 , 14 , 23 , 26 ] ont montré une baisse des taux de fructosamine et d’HbA1c après le jeûnee. Une étude a noté une augmentation de l’HBA1C expliquée par la mauvaise observance du traitement [ 25 ].…”

The effect of vildagliptin relative to sulphonylureas in Muslim patients with type 2 diabetes fasting during Ramadan: the VIRTUE study

“…This positive result is noteworthy in that it was achieved without episodes of severe hypoglycaemia in the vildagliptin cohort, and is consistent with findings from previous vildagliptin research undertaken in this patient population ( 11 , 12 ). Related to this end-point, a descriptive analysis assessing the usage of individual SUs and the frequency of HEs with these SUs is particularly interesting; the data suggest a preference for the use of glimepiride and gliclazide (approximately three quarters of the latter appeared to receive the modified release formulation of gliclazide), as opposed to glibenclamide, presumably as a consequence of the higher incidence of HEs reported previously with glibenclamide ( 13 – 15 ). Reassuringly, vildagliptin appeared to be associated with a lower incidence of HEs regardless of the individual SU employed; it is not immediately apparent as to why this consistent effect was not observed in studies with other DPP-4 inhibitors ( 14 , 16 ).…”

Safety of high-risk diabetic patients during Ramadan at a tertiary care hospital in Pakistan, practicing updated IDF DAR guidelines

“…Human insulin 70/30 use in patients with Type-2 diabetes in Ramadan when compared with insulin lispro Mix25 resulted in better glucose control before and after Iftar with less glycemic variations. 18 The long acting basal analogue insulin works better by having flat curve and less chances of hypoglycemia for obvious reasons. Glargine has been studied to be safe and effective and results in less glycemic variations alone or in combination with other medications.…”

Prise en charge des patients diabétiques au cours du jeun du Ramadan: application des recommandations internationales en pratique clinique

“…Poids et apport calorique: nous remarquons l’absence d’effet significatif du jeûne du mois de Ramadan sur le poids, avec un faible taux d’écart diététique comparé à d’autres études [ 6 , 12 ]. Plusieurs études ont noté l’absence d’effet significatif du jeûne sur le poids [ 14 , 16 ].…”

“…Ce qui est en accord avec plusieurs études [ 8 , 9 , 11 ] rapportant que le jeûnee du Ramadan ne s’est pas accompagné de modifications du taux d’HbA1c, ceci est d’autant plus marqué si les patients sont préparés au jeûne. Toutefois, certaines études [ 6 , 8 , 14 , 23 , 26 ] ont montré une baisse des taux de fructosamine et d’HbA1c après le jeûnee. Une étude a noté une augmentation de l’HBA1C expliquée par la mauvaise observance du traitement [ 25 ].…”