Proper combination of medications key to diabetes control during Ramadan

Taking the proper combination of diabetes medications while fasting during Ramadan can significantly reduce the risk of those with type 2 diabetes suffering a hypoglycaemic event – where blood sugar becomes dangerously low – according to a recent study.

The UK research, published in Current Medical Research and Opinion, investigated the effects of different treatments on diabetes control in 72 Muslims with type 2 diabetes, who were fasting for 11-20 hours per day during the holy month of Ramadan.

The study found that those taking metformin in combination with Galvus (vildagliptin) experienced no hypoglycemic episodes during the 16 week study, compared with those who took metformin and sulphonylurea of which more than 40 percent suffered such an event.

To promote increased awareness amongst health care practitioners and patients on the importance of blood sugar control during the holy month, the study’s author Dr Mohamed Hassanein, Diabetes and Endocrinology Consultant and Honorary Senior Lecturer at Cardiff University in the UK, has embarked on a speaker tour across the Gulf, landing in Qatar last week to speak with locals.

“Fasting in Ramadan is a great passion for Muslims and that includes those with diabetes. The problem is that they can experience very high or very low blood sugar levels during the month, especially after breaking their fast,” said Dr. Hassanein.

“The results from the study show that fasting Muslim patients are able to fulfil their religious obligation without risk of harming themselves – which is important as sometimes the passion of the patient overrides the advice from  their doctor, despite certain high risk groups being exempt from fasting according to religious text,” he added.

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Other findings reveal that blood glucose levels in the metformin and vildagliptin group after Ramadan were near recommended levels than the metformin and sulphonylurea group. The former group also reported no adverse events during the study, whereas 50 percent of the latter group had at least one adverse event.

The findings underscore the importance of doctors prescribing the correct medications for patients, especially at times when food intake is low or sporadic. Dr Hassanein said the study’s findings were significant for Muslim patients with type 2 diabetes, as even in cases where doctors advised against fasting, patients tended to fast regardless.

“When extrapolated to the global Muslim population with a similar clinical background, these findings could have considerable public health and clinical implications,” he said.

Symptoms of hypoglycaemia include nervousness, sweating, intense hunger, trembling, weakness, palpitations, and sufferers often have trouble speaking. In severe cases people require hospitalisation and it can even lead to coma and death. Research suggests that the overall mortality rate of severe hypoglycaemia – when induced by treatment with sulphonylurea alone – is around nine percent.

The cost implications of severe hypoglycaemia are also important for healthcare organisations to note, with each hospital admission for a severe event estimated to cost in the UK region of ~£1,000 (QAR 5,600).

Vildagliptin is a DPP-4 inhibitor that works by blocking the breakdown of ‘incretin’ hormones in the body that stimulate the pancreas to produce insulin. Its mechanism of action targets the dysfunction in the pancreatic islet alpha and beta cells that cause high blood sugar levels in people with type 2 diabetes.

“The field of diabetes, with specific regard to Ramadan, has become very dynamic. There is a lot of active work on the role of structured medication regimens for Muslim patients in terms of improved safety and patient outcomes for those that are medically fit to fast – within the next two to three years we hope to have enough information to update guidelines for fasting patients,” added Dr Hassanein.