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Original Article

Hypoglycaemia in sulphonylurea-treated subjects with type 2 diabetes undergoing Ramadan fasting: a five-country observational study

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Pages 1237-1242 | Accepted 02 Apr 2011, Published online: 20 Apr 2011
 

Abstract

Objectives:

To determine the incidence of hypoglycaemia during Ramadan in Muslim subjects with type 2 diabetes treated with a sulphonylurea.

Methods:

In an observational study, eligible subjects were Muslims with type 2 diabetes (age ≥18 years) who were treated with glimepiride, gliclazide, or glibenclamide with or without metformin and who expressed their intention to fast during Ramadan in 2009. Subjects were recruited by clinicians in India, Malaysia, Israel, the United Arab Emirates (UAE), and Saudi Arabia. Each day during Ramadan, patients completed diary cards, which collected information regarding hypoglycaemic symptoms and complications, time from last meal and from last medication, self-monitored blood glucose measurements, and need for assistance. The overall incidence of symptomatic hypoglycaemia recorded during Ramadan was the primary endpoint of interest.

Results:

Of the enrolled subjects (N = 1397), 1378 returned their diary cards at study end and were included in the analysis. Overall, 89% of subjects who expressed their intention to fast prior to Ramadan reported that they observed the fast during Ramadan. A total of 271 subjects (19.7%) experienced one or more symptomatic hypoglycaemic events during Ramadan, with incidences of 25.6%, 16.8%, and 14.0% observed in subjects treated with glibenclamide, glimepiride, and gliclazide, respectively. By country, the highest incidence of hypoglycaemia was reported by subjects from Israel (40%) followed by those from Malaysia (24%), the UAE (18%), India (13%), and Saudi Arabia (10%). The overall incidence of severe hypoglycaemic events (i.e., events requiring medical or non-medical assistance) was 6.7%, with the highest incidence occurring in the glibenclamide group.

Limitations:

This was an observational study and as such subjects were not randomised to treatments. While baseline measures appeared comparable, it is possible that differences in measured and unmeasured patient characteristics (e.g., measures of glycaemic control) could partially explain these results. Lastly, no inferential testing was performed on the comparisons between sulphonylurea types and/or countries.

Conclusions:

In this five-country observational study, nearly 20% of sulphonylurea-treated Muslim subjects with type 2 diabetes experienced symptomatic hypoglycaemia while fasting during Ramadan, with variations across sulphonylureas and countries.

Transparency

Declaration of funding

The study was funded by Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA.

Declaration of financial/other relationships

S.R.A., K.A.T. and S.B.I. have disclosed that they have no relevant financial relationships. G.K. has disclosed that he is on the advisory board for Januvia, an MSD-marketed diabetes product and receiving honoraria as a speaker at MSD sponsored meetings. N.S. has disclosed receiving research funding from MSD. R.B., O.H., N.L. and R.L. have disclosed that they are employees of Syreon Corporation, the contract research organisation, which received funding from Merck Sharp & Dohme Corp. to conduct the present study. C.G., B.J.M., M.J.D., H.L.K., S.S.E. and L.R. have disclosed that they are employees of Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA and may have or own company stock or stock options.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgements

Author contributions

C.J.G., B.J.M., H.L.K., S.S.E. and L.R. were involved in the concept and design of the study. S.R.A., K.A.T., S.B.I., G.K., R.L., R.B., N.L., O.H. and L.R. were involved in the data collection and/or analysis. All authors were involved in interpretation of the results. M.J.D. and L.R. drafted the article and all authors were involved in the critical revision and approval of the article.

Ramadan 2009 study investigators by country

India: S.R. Aravind, S. Dube, J.B. Gupta, S. Jain, U. Sriram; Israel: F. Adawi, I. Harman, N. Shehadeh; Malaysia: A.B. Abdul Aziz, S.P. Daljit, S. Hamimah, S.B. Ismail, B.K. Ho, I. Mastura, A.S. Narul, N.M. Noor, A. Sanidah, R. Sukumar, T.S. Wahyu, F.C. Yew; Saudi Arabia: E. Aldhafiri, A. Almansari, K. Arafat, M. Elmourad, A.M.H. Al Elq, O. Al Khatib, H. Raef, S. Safarini, K.A. Allah Al Tayeb; United Arab Emirates: G. Kaddaha.

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