Safety and effectiveness of non‐insulin glucose‐lowering agents in the treatment of people with type 2 diabetes who observe R amadan: a systematic review and meta‐analysis

Mar 18, 2015Diabetes, obesity & metabolism

Safety and effectiveness of non-insulin diabetes medicines during Ramadan fasting in people with type 2 diabetes

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Abstract

Sitagliptin reduced the occurrence of hypoglycaemic episodes during Ramadan by 52% compared to sulphonylureas.

Dipeptidyl peptidase-4 (DPP-4) inhibitors are associated with fewer hypoglycaemic events compared to sulphonylureas.
Observational studies showed a significant reduction in hypoglycaemic episodes with vildagliptin, with a risk ratio of 0.28.
Significant reductions in both glycated haemoglobin (HbA1c) and weight were observed with vildagliptin compared to sulphonylureas.
Liraglutide is linked to significant weight loss (-1.81 kg) compared to sulphonylureas.
Pioglitazone is associated with a significant weight increase (3.48 kg) compared to placebo.

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AIM: To determine which non-insulin glucose-lowering treatment regimens are most appropriate in people with type 2 diabetes who choose to fast during Ramadan.

METHODS: Electronic databases were searched for randomized controlled trials (RCTs) and observational studies that compared non-insulin glucose-lowering agents in people with type 2 diabetes fasting during Ramadan. Those studies which reported hypoglycaemia, weight and glycated haemoglobin (HbA1c) change were included. Data were pooled using random effects models.

RESULTS: A total of 16 studies were included: 9 RCTs and 7 observational studies. There was evidence that dipeptidyl peptidase-4 (DPP-4) inhibitors led to fewer hypoglycaemic events compared with sulphonylureas. Sitagliptin significantly reduced the number of patients with ≥1 hypoglycaemic episodes during Ramadan [risk ratio (RR) 0.48, 95% confidence interval (CI) 0.36, 0.64; p > 0.0001]. This was not replicated in the RCTs of vildagliptin, but a significant reduction was found in the observational studies (RR 0.28, 95% CI 0.10, 0.75; p = 0.01) with high heterogeneity (I(2) = 86.7%). Significant reductions in HbA1c and weight were seen in the observational studies of vildagliptin versus sulphonylureas. The use of liraglutide led to significant weight loss (-1.81 kg, 95% CI -2.91, -0.71; p = 0.001) compared with sulphonylureas. Pioglitazone significantly increased weight compared with placebo (3.48 kg, 95% CI 2.82, 4.14; p < 0.0001).

CONCLUSIONS: The analysis supports the use of DPP-4 inhibitors during Ramadan rather than sulphonylureas for reduction in hypoglycaemia without a cost to diabetes control and weight. The glucagon-like peptide (GLP)-1 agonist liraglutide provides clinical benefits, but more studies are required. RCTs of DPP-4 inhibitors compared with GLP-1 agonists and novel therapies including the sodium-glucose co-transporter 2 and α-glucosidase inhibitors are needed to inform evidence-based guidelines.

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Safety and effectiveness of non‐insulin glucose‐lowering agents in the treatment of people with type 2 diabetes who observe R amadan: a systematic review and meta‐analysis

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