Role of oral hypoglycemic agents in the management of type 2 diabetes mellitus during Ramadan

Mir Iftikhar Bashir; Md Faruque Pathan; Syed Abbas Raza; Jamal Ahmad; AK Azad Khan; Osama Ishtiaq; Rakesh K Sahay; Aisha Sheikh; Abdul Hamid Zargar

doi:10.4103/2230-8210.97994

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SOUTH ASIAN GUIDELINES FOR MANAGEMENT OF ENDOCRINE DISORDERS IN RAMADAN

Year : 2012 | Volume : 16 | Issue : 4 | Page : 503-507

Role of oral hypoglycemic agents in the management of type 2 diabetes mellitus during Ramadan

Mir Iftikhar Bashir¹, Md Faruque Pathan², Syed Abbas Raza³, Jamal Ahmad⁴, AK Azad Khan⁵, Osama Ishtiaq⁶, Rakesh K Sahay⁷, Aisha Sheikh⁸, Abdul Hamid Zargar⁹
¹ Department of Endocrinology, SKIMS, Srinagar, Jammu and Kashmir, India
² Department of Endocrinology, BIRDEM, Dhaka, Bangladesh
³ Department of Endocrinology, Shaukhat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
⁴ Rajiv Gandhi Centre for Diabetes and Endocrinology, Faculty of Medicine, J. N. Medical College, Aligarh Muslim University, Aligarh, India
⁵ President, Diabetic Association of Bangladesh, Dhaka, Bangladesh
⁶ Department of Endocrinology, Shifa International Hospital, Islamabad, Pakistan
⁷ Department of Endocrinology, Osmania Medical College, Hyderabad, India
⁸ Section of Endocrinology, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
⁹ Advanced Center for Diabetes and Endocrine Care, Srinagar, Jammu and Kashmir, India

Correspondence Address:
Abdul Hamid Zargar
Advanced Center for Diabetes & Endocrine Care, National Highway, Gulshan Nagar, Chanapora, Srinagar - 190 015, Jammu and Kashmir
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/2230-8210.97994

It is obligatory for all adult Muslims to observe fast during the holy month of Ramadan, but sick individuals including those with diabetes mellitus are exempted from the duty of fasting. Specific medical advice must be provided to individual patients concerning the potential risks they must accept if they decide to fast. Any alteration in medications deemed necessary to provide an effective and safe antidiabetic regimen should be instituted well before the start of Ramadan. Diet-controlled patients and those well controlled on insulin sensitizers have low risk of hypoglycemia and may safely fast with some modification in the timing of the doses. Newer generation sulfonylureas (gliclazide MR and glimepiride) have reasonable safety profile during Ramadan fasting and are economical options for a large number of diabetics worldwide, especially in the developing countries; older, long acting sulfonylureas like glibenclamide and chlorpropamide should be avoided during fasting. Oral DPP-IV inhibitors are important substitutes to sulfonylureas for patients with diabetes mellitus during fasting owing to their glucose-dependent mechanism of action, efficacy, and tolerability. This group of drugs causes a moderate A1c reduction, are weight neutral, and have a very low risk of hypoglycemia. Short-acting insulin secretagogues are an option in the subset of fasting diabetic patients who have predominantly post-prandial hyperglycemia.

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