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Letter

Pharmacological approaches to the management of type 2 diabetes in fasting adults during Ramadan

Pages 293-294 | Published online: 15 Aug 2012

Dear editor

I read with great interest the recent review article by Almaatouq regarding the pharmacological approaches to the management of type 2 diabetes in fasting adults during Ramadan.Citation1 This article stated that “A recent prospective study of more than 1000 patients with T2DM who fasted during Ramadan found that the risk of hypoglycemia associated with a vildagliptin-based regimen (vildagliptin 100 mg once daily) was lower than that of a sulfonylurea-based regimen (both with and without metformin).”Citation1 This statement needs to be corrected.

Ramadan is the lunar month observed each year in which Muslim adults will fast. This fast includes abstinence from eating, drinking, and smoking from sunrise to sunset. Hypoglycemia during this period represents the greatest health risk for these patients. Recently introduced modulators of the incretin system are the dipeptidylpeptidase- 4 inhibitors, which include sitagliptin, vildagliptin, alogliptin, saxagliptin, and linagliptin. These agents are not associated with hypoglycemia.

Two of these agents have been studied during the Ramadan fast.Citation2,Citation3 A retrospective data audit of 100 patients taking 50 mg of vildagliptin twice daily found that the incidence of hypoglycemia in such patients is less than that of patients with T2DM taking gliclazide during Ramadan.Citation2 While sitagliptin was the first agent approved in the class, it is also the only agent in the class that has been studied in a large, randomized, controlled prospective trial of T2DM patients during Ramadan. In this study, 1066 adult patients with T2DM who were treated with stable doses of a sulphonylurea with or without metformin for at least three months before screening and intended to fast during Ramadan were randomized in a 1:1 ratio to either switch to 100 mg/day sitagliptin or remain on their prestudy sulphonylurea. At its conclusion, it was found that the risk of symptomatic or severe hypoglycemia in patients switched to a sitagliptin-based regimen (100 mg of sitagliptin once daily) was significantly decreased compared to those who remained on a sulphonylurea-based regimen during Ramadan.Citation3

It is thus clearly important that readers understand these facts about the use of both agents in patients fasting during Ramadan.

Disclosure

The author reports no conflicts of interest in this work.

References

  • Almaatouq MA Pharmacological approaches to the management of type 2 diabetes in fasting adults during Ramadan Diabetes Metab Syndr Obes 2012 5 109 119 22654520
  • Devendra D Gohel B Bravis V Vildagliptin therapy and hypoglycaemia in Muslim type 2 diabetes patients during Ramadan Int J Clin Pract 2009 63 1446 1450 19678856
  • Al Sifri S Basiounny A Echtay A The incidence of hypoglycaemia in Muslim patients with type 2 diabetes treated with sitagliptin or a sulphonylurea during Ramadan: a randomised trial Int J Clin Pract 2011 65 11 1132 1140 21951832