Khalil Hany Ahmed Muhammed, Abdelal Sara Kasem, El-Rawy Ahmed Faysal, Abodahab Alshimaa Lotfy Hamed
Internal Medicine Department, Faculty of Medicine, Sohag University, Sohag, Egypt.
Cardiovascular Disease Department Faculty of Medicine, Sohag University, Sohag, Egypt.
J Diabetes Res. 2025 Apr 25;2025:4321423. doi: 10.1155/jdr/4321423. eCollection 2025.
Ramadan fasting claims a necessary role in the 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 (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable 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. 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 6 weeks after Ramadan, evaluations were conducted. 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 DKA did not occur in any patient. There was a significant negative correlation between age and HbA1c ( = -0.267, 95% CI: -0.48 to -0.05; = 0.037) and eGFR ( = -0.684, 95% CI: -0.79 to -0.54; < 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) ( < 0.05). SGLT2i is effective and safe during Ramadan fasting with a significant reduction in HBA1c, blood pressure, and creatinine and a significant elevation of eGFR. ClinicalTrials.gov identifier: NCT06370247.
斋月禁食在糖尿病管理中发挥着重要作用。许多2型糖尿病患者坚持在斋月期间禁食，这给医生带来了挑战，即要在预防低血糖或糖尿病酮症酸中毒（DKA）与良好控制高血糖及其短期和长期并发症之间找到平衡。钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）是一种用于治疗2型糖尿病的降糖疗法，通常耐受性良好，但可能有脱水和低血糖风险，尤其是在长时间禁食期间。该研究旨在评估斋月禁食期间首次使用SGLT2i的疗效和安全性。这项前瞻性队列研究对61名年龄≥18岁、男女皆有、患有2型糖尿病（T2DM）、准备在斋月期间禁食且首次将SGLT2i作为二甲双胍或其他口服降糖药补充剂进行治疗的埃及穆斯林患者进行。SGLT2i的剂量在开斋时间后开始。在斋月期间及斋月结束后6周进行评估。斋月结束后糖化血红蛋白（HbA1c）、血压（收缩压和舒张压）和肌酐显著低于斋月开始时。估计肾小球滤过率（eGFR）在斋月结束后显著高于斋月开始时。所有患者均未发生低血糖、脱水和DKA。斋月结束后，年龄与HbA1c（r = -0.267，95%CI：-0.48至-0.05；P = 0.037）和eGFR（r = -0.684，95%CI：-0.79至-0.54；P < 0.001）之间存在显著负相关，而糖尿病病程与斋月前后的HbA1c之间无相关性。在患有缺血性心脏病（IHD）、高血压（HTN）、周围神经病变（PN）和慢性肾脏病（CKD）的患者中，斋月结束后的HbA1c显著低于斋月期间（P < 0.05）。斋月禁食期间SGLT2i有效且安全，HbA1c、血压和肌酐显著降低，eGFR显著升高。ClinicalTrials.gov标识符：NCT06370247。
