Division of Endocrinology and Metabolism, American University of Beirut, Beirut, Lebanon.
Diabet Med. 2009 Dec;26(12):1255-61. doi: 10.1111/j.1464-5491.2009.02836.x.
To determine the safety and efficacy of insulin glargine and glimepiride in patients with Type 2 diabetes before and after Ramadan and during fasting for Ramadan.
In this open, descriptive, multi-centre, prospective study, insulin-naïve (n = 100) or previously insulin-treated (n = 249) patients with Type 2 diabetes received insulin glargine [titrated from 10 U daily according to fasting blood glucose (FBG)] and glimepiride (4 mg daily). The number and type of hypoglycaemic episodes and glycaemic control were assessed before, during and after Ramadan. Bivariate logistic regression analyses were used to identify factors which predicted hypoglycaemia during Ramadan.
Only one episode of severe hypoglycaemia occurred in each time period before, during and after Ramadan. Mild hypoglycaemic episodes increased from 156 pre-Ramadan to 346 during Ramadan (P < 0.001) and decreased to 153 post-Ramadan (P = 0.0002).The increase during Ramadan was mainly attributed to increased symptomatic hypoglycaemic episodes. FBG and glycated haemoglobin improved during the titration period and did not change during the rest of the study. Risk of hypoglycaemic events during Ramadan was higher in countries where fasting is strict [odds ratio (OR) 3.69 (2.06-6.63), P < 0.0001]. Lower weight [< 70.0 kg; OR 2.56 (1.46-4.48), P = 0.001] and waist circumference [< 90 cm; OR 3.06 (1.62-5.78), P = 0.001] increased the risk of hypoglycaemia during Ramadan whilst FBG > 6.7 mmol/l [OR 0.3 (0.17-0.54), P < 0.0001] had a protective effect.
Combination of insulin glargine and glimepiride may be used during Ramadan in patients with Type 2 diabetes who wish to fast, provided glimepiride is given at the time of breaking the fast and insulin glargine titrated to provide FBG > 6.7 mmol/l.
在开斋节前、斋月期间和开斋节后，评估甘精胰岛素和格列美脲在 2 型糖尿病患者中的安全性和疗效。
在这项开放、描述性、多中心、前瞻性研究中，100 例从未使用过胰岛素（n = 100）或之前使用过胰岛素（n = 249）的 2 型糖尿病患者接受了甘精胰岛素（根据空腹血糖（FBG）从 10 U/d 开始滴定）和格列美脲（4 mg/d）治疗。在开斋节前、斋月期间和开斋节后评估低血糖发作的次数和类型以及血糖控制情况。采用二项逻辑回归分析来识别预测斋月期间低血糖的因素。
在开斋节前、斋月期间和开斋节后，每个时间段仅发生 1 例严重低血糖事件。轻度低血糖发作从开斋节前的 156 次增加到斋月期间的 346 次（P < 0.001），并在开斋节后减少到 153 次（P = 0.0002）。斋月期间的增加主要归因于症状性低血糖发作的增加。在滴定期间，FBG 和糖化血红蛋白得到改善，在研究的其余时间没有变化。在禁食严格的国家，发生低血糖事件的风险更高[比值比（OR）3.69（2.06-6.63），P < 0.0001]。体重较低[< 70.0 kg；OR 2.56（1.46-4.48），P = 0.001]和腰围较大[< 90 cm；OR 3.06（1.62-5.78），P = 0.001]增加了低血糖的风险，而 FBG > 6.7 mmol/L [OR 0.3（0.17-0.54），P < 0.0001]具有保护作用。
在希望斋戒的 2 型糖尿病患者中，可在斋月期间使用甘精胰岛素和格列美脲联合治疗，但应在开斋时给予格列美脲，并将甘精胰岛素滴定至 FBG > 6.7 mmol/L。
