First-time Usage of SGLT2 Inhibitors in Patients with Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety

Abstract Introduction: Ramadan fasting claims a necessary role in management of diabetes. Many people with type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a glucose-lowering therapy for type 2 diabetes which are generally well tolerated but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first-time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and Six weeks after Ramadan, evaluations were conducted. Results: Glycated hemoglobin (HbA1c), blood pressure (systolic and diastolic), and creatinine were significantly lower after Ramadan than at the beginning of Ramadan. The estimated glomerular filtration rate (eGFR) was significantly higher after Ramadan than at the beginning of Ramadan. Hypoglycemia, dehydration, and diabetic ketoacidosis (DKA) did not occur in any patient. There was a significant negative correlation between age and HbA1c (r=-0.267, P = 0.037) and eGFR (r =-0.684, P < 0.001) after Ramadan while there was no correlation between the duration of DM and HbA1c before and after Ramadan. HbA1c was significantly lower after Ramadan than during Ramadan in patients with ischemic heart disease (IHD), hypertension (HTN), peripheral neuropathy (PN), and chronic kidney disease (CKD) (P < 0.05). Conclusions: SGLT2i is effective and safe during Ramadan fasting with a significant reduction in HBA1c, blood pressure, and creatinine and a significant elevation of eGFR. Trial registration Clinical Trials giv ID: NCT06370247