Abstract
AimsThis 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. MethodsA 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. ResultsA 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. ConclusionsThis systematic review and meta-analysis shows clinical benefits with the newer glucose lowering medications in patients with T2DM who fast during Ramadan.
Highlights
The prevalence of diabetes is increasing globally, especially in the Muslim majority regions of the Middle East, North Africa and South East Asia which currently have the highest age-adjusted prevalence of diabetes in adults [1]
The Epidemiology of Diabetes and Ramadan (EPIDIAR) [2] study showed that 89% of patients with type 2 diabetes mellitus (T2DM) fasted during Ramadan and this was associated with an increased incidence of severe hypoglycemia and hyperglycemia with/without ketoacidosis requiring hospitalization
Analysis was undertaken to assess the effect of dipeptidyl peptidase-4 inhibitor (DPP-4i), glucagon-like peptide-1 receptor agonist (GLP-1), and sodium-glucose transport-2 inhibitors (SGLT-2i) on the following variables: HbA1c (%); weight; systolic blood pressure (SBP) and diastolic blood pressure (DBP); and hypoglycemia
Summary
The prevalence of diabetes is increasing globally, especially in the Muslim majority regions of the Middle East, North Africa and South East Asia which currently have the highest age-adjusted prevalence of diabetes in adults [1]. The majority of Muslims observe fasting, an obligatory pillar of their faith. The Epidemiology of Diabetes and Ramadan (EPIDIAR) [2] study showed that 89% of patients with type 2 diabetes mellitus (T2DM) fasted during Ramadan and this was associated with an increased incidence of severe hypoglycemia and hyperglycemia with/without ketoacidosis requiring hospitalization. More recently the CREED study [3] showed that almost 95% of patients with T2DM on oral hypoglycemic agents (OHA) fasted during Ramadan and this was associated with an increased incidence of hypoglycemia
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