Repaglinide plus single-dose insulin glargine: a safe regimen for low-risk type 2 diabetic patients who insist on fasting in Ramadan

Abstract

Aim of this prospective study is to evaluate the effect of repaglinide t.i.d. (three times a day) plus single-dose insulin glargine regimen in low-risk type 2 diabetic patients during Ramadan fasting. Participants had been taking the regimen for at least 3 months. Patients with a history of diabetic coma, severe hypoglycemic crisis or repeating attacks of hypoglycemia were excluded. Hypoglycemic unawareness, kidney or liver disease or HbA1c over 8% were also accepted as exclusion criteria. Eleven patients who insisted on this worship and eight non-fasting cases were involved. All were told to make home-glucose-monitorisation weekly and report any hypoglycemic event throughout Ramadan. Fasting blood glucose (FBG), post-prandial blood glucose (PBG) and fructosamine levels, body weights and blood pressures were recorded just before and after Ramadan. Seven patients in each group concluded the follow-up. Any significant change was detected in the parameters in either groups (P>0.05). Glucose control remained unchanged; fructosamine 318.14+/-65.38 versus 317.28+/-52.80 mmol/L in fasting group, 290.71+/-38.48 versus 290+/-38.56 mmol/L in non-fasting group. None of them exhibited either a major or a minor hypoglycemic event. The results of this pilot study indicated that repaglinide t.i.d. plus single-dose insulin glargine regimen was safe for low-risk type 2 diabetic patients who insisted on fasting during Ramadan.

Diabetes and Ramadan: Practical guidelines

“…Two smaller observational studies found insulin glargine to be safe to use during Ramadan, with no significant increases in hypoglycaemia when compared with non-fasting individuals or when compared with those taking OADs [26,28].…”

“…In two small observational studies, no hypoglycaemic events were reported in patients treated with repaglinide during Ramadan [26,27]. A third study demonstrated no difference in hypoglycaemia when compared with insulin glargine or glimepiride, a sulphonylurea (SU) therapy [28].…”

Diabetes Mellitus and Ramadan: Physiopathological, Clinical and Therapeutic Aspects

“…No significant differences were reported amongst the three phases of the study. The risk of hypoglycaemia did not differ in the sample in the study compared to control and does not show any difference among the three treatment regimens (Bakiner et al, 2009;Cesur et al, 2007).…”

“…Bakiner et al have reported that a dose of repaglinide taken before the two main meals of the day in addition to a single insulin glargine is safe and it does not provoke hypoglycaemia or changes in body weight in low-risk individuals committing to fasting (Bakiner et al, 2009). …”

The Effect of Nutritional Education Program Based on Health Belief Model (HBM) on the Knowledge of Fasting Type 2 Diabetic Patients

“…The advantages and disadvantages of fasting in patients with type 2 diabetes are still under consideration. Despite the conflicting results of some studies (19), the results show that fasting during Ramadan can lead to increase the risk of hypoglycemia and hyperglycemia in the patients with type 1 and 2 diabetes (2).…”