Diabetic Patients Fasting During Ramadan: Ten Years Overview

Aim: Many diabetic patients insist on fasting in Ramadan despite the potential risks of hypoglycemia, hyperglycemia, diabetic ketoacidosis and diabetic hyperosmolar coma. These patients represent a challenge not only for themselves, but also for the professional care providers during this period that lasts a full month. Aim of this review to provide health care practitioners with new data published in the last ten years regarding the impact of new therapeutic modalities during Ramadan focusing on hypoglycemic events and weight change. Methods: A Pubmed search was conducted using the search terms: “ Ramadan, fasting and diabetes, incretin-based therapy, insulin and fasting Ramadan, oral hypoglycemic agents, Ramadan fasting and hypoglycemia”. Our search has been restricted for the last ten years between 20052015 frame times, English Language. All randomized and observational trials in patients with type 2 diabetes fasting during Ramadan have been included in this Review. Results: The database search disclosed the importance of pre Ramadan period focusing on structured diabetes education, the introduction of the Managing Diabetes Ramadan Conversation Map TM by Eli Lilly company, representing one of the important tools that help health care providers and patients manage a safer Ramadan fasting. Most of the recent trials focused mainly on incretin-based therapy during Ramadan fasting, taking into account their low risk of hypoglycemic events and a weight neutral/reduction effect. Sitagliptin and vildagliptin were the only two drugs evaluated during Ramadan. The rate of hypoglycemic events was lower using these two agents in comparison with sulfonylureas. Weight reduction was observed with vildagliptin, whereas this parameter was not assessed in sitagliptin trials. Liraglutide was the only glucagon like peptide receptor agonist studied during Ramadan with its beneficial effect on glycated hemoglobin A1c, weight reduction and less hypoglycemic events. Treatment with Glilazide is safer than other sulfonylurea agents. The use of insulin analogues in the last ten years is better than human insulin during Ramadan fasting. Conclusion: Dipeptidyl peptidase inhibitors and glucagon like peptide-1 receptor agonists are considered favorable for use during and after Ramadan due to their lower rate of hypoglycemic events and weight neutral/loss effect during and after Ramadan. This Review and for the first time highlights the weight changes that occur during Ramadan treatment in type 2 diabetic patients treated with dipeptidyl peptidase inhibitors. Gliclazide treatment with its lower rate of hypoglycemic events might be a suitable option for patients who fast Ramadan.