Background: Diabetic management during Ramadan fasting is a significant clinical challenge. Sodium glucose co-transporter-2 inhibitors (SGLT2i) are new class of antidiabetic medications known for low frequency of associated hypoglycemia. The present study aimed to evaluate efficacy, safety and tolerability of SGLT2i in diabetic patients practicing Ramadan fasting. Patients and methods: The study included 94 patients. They comprised 51 patients who received metformin and sulfonylureas (SU): glimepiride (1-6 mg/d) or gliclazide MR (60-120mg/d) and 43 patients who received metformin and SGLT2i: empagliflozin (25 mg), dapagliflozin (10 mg) or canagliflozin (300 mg). The study outcome parameters were frequency of hypoglycemia episodes, volume depletion episodes, number of days with early breaking of fasting and missed fasting days. Results: It was found that patients in SGLTi group experiences significantly fewer symptomatic (9.3% versus 35.3%, p= 0.003) and documented (7.0% versus 25.5%, p= 0.017) hypoglycemic episodes as compared to the SU group. However, there were no significant differences between the studied groups regarding the frequency of patients with volume depletion episodes (5.9% versus 16.3%, p= 0.1). Moreover, there were no significant differences between groups regarding the frequency of patients with early breaking of fasting (11.8% versus 9.3%, p= 0.7) or missed fasting (3.9% versus 2.3%, p= 0.66). None of the studied patients discontinued the prescribed medications. Conclusions: SGLT2i combined with metformin for diabetic patients during Ramadan fasting are effective, safe and well-tolerated with the advantage of reduced hypoglycemic events.

Abstract

Background: Diabetic management during Ramadan fasting is a significant clinical challenge. Sodium glucose co-transporter-2 inhibitors (SGLT2i) are new class of antidiabetic medications known for low frequency of associated hypoglycemia. The present study aimed to evaluate efficacy, safety and tolerability of SGLT2i in diabetic patients practicing Ramadan fasting. Patients and methods: The study included 94 patients. They comprised 51 patients who received metformin and sulfonylureas (SU): glimepiride (1-6 mg/d) or gliclazide MR (60-120mg/d) and 43 patients who received metformin and SGLT2i: empagliflozin (25 mg), dapagliflozin (10 mg) or canagliflozin (300 mg). The study outcome parameters were frequency of hypoglycemia episodes, volume depletion episodes, number of days with early breaking of fasting and missed fasting days. Results: It was found that patients in SGLTi group experiences significantly fewer symptomatic (9.3% versus 35.3%, p= 0.003) and documented (7.0% versus 25.5%, p= 0.017) hypoglycemic episodes as compared to the SU group. However, there were no significant differences between the studied groups regarding the frequency of patients with volume depletion episodes (5.9% versus 16.3%, p= 0.1). Moreover, there were no significant differences between groups regarding the frequency of patients with early breaking of fasting (11.8% versus 9.3%, p= 0.7) or missed fasting (3.9% versus 2.3%, p= 0.66). None of the studied patients discontinued the prescribed medications. Conclusions: SGLT2i combined with metformin for diabetic patients during Ramadan fasting are effective, safe and well-tolerated with the advantage of reduced hypoglycemic events.