Use of SGLT2 inhibitors during Ramadan: a survey of physicians’ views and practical guidance

Abstract

Background and Objectives: SGLT2 inhibitors are a new glucose-lowering therapy for type 2 diabetes. There are no recommendations for their use for patients fasting for Ramadan. Methods: We surveyed physicians regarding management of people with type 2 diabetes on SGLT2 inhibitors intending to fast for Ramadan. Results: Most of the responding 197 physicians had substantial experience with patients who fast for Ramadan, with 18.6% having 25–50% such patients, 18.2% having 50–75% and 23.6% having >75%. Most physicians were fully confident (49.4%) or fairly confident (34.4%) about diabetes management during Ramadan. Risks of hypoglycaemia (98.1%) and dehydration (83.1%) were identified more often than hyperglycaemias (67.5%), diabetic ketoacidosis (63.8%) and thromboembolic disease (45.2%). The majority felt that SGLT2 inhibitors were generally appropriate and safe during Ramadan but should be discontinued in selected patients (70.6%). Most respondents (92.2%) would advise taking an SGLT2 inhibitor with the first evening meal (Iftar), but 6.1% advised taking them before the last pre-dawn meal (Suhour). Taking extra clear fluids in the evening of Ramadan was recommended by the majority. Conclusions: This survey will help to inform interpretation of future studies towards the development of clinical guidelines for SGLT2 inhibitor use during Ramadan. The majority of physicians believe that SGLT2 inhibitors are generally safe for patients with diabetes who intend to observe Ramadan fasting, but should be discontinued for selected patients. We provide practical advice for physicians in this setting.