Strategies to Make Ramadan Fasting Safer in Type 2 Diabetics: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials and Observational Studies

Shaun Wen Huey Lee, Jun Yang Lee, Christina San San Tan, Chee Piau Wong, Shaun Wen Huey Lee, Jun Yang Lee, Christina San San Tan, Chee Piau Wong

Abstract

Ramadan is the holy month for Muslims whereby they fast from predawn to after sunset and is observed by all healthy Muslim adults as well as a large population of type 2 diabetic Muslims.To determine the comparative effectiveness of various strategies that have been used for type 2 diabetic Muslim who fast during Ramadan.A systematic review and network meta-analysis of randomized controlled studies (RCT) as well as observational studies for patients with type 2 diabetes who fasted during Ramadan was conducted. Eight databases were searched from January 1980 through October 2015 for relevant studies. Two reviewers independently screened and assessed study for eligibility, assessed the risk of bias, and extracted relevant data. A network meta-analysis for each outcome was fitted separately, combining direct and indirect evidence for each comparison.Twenty-nine studies, 16 RCTs and 13 observational studies each met the inclusion criteria. The most common strategy used was drug changes during the Ramadan period, which found that the use of DPP-4 (Dipeptidyl peptidase inhibitor -4) inhibitors were associated with a reduction in incidence of experiencing hypoglycemia during Ramadan in both RCTs (pooled relative risk: 0.56; 95% confidence interval: 0.44-0.72) as well as in observational studies (pooled relative risk: 0.27; 0.09-0.75). Ramadan-focused education was shown to be beneficial in reducing hypoglycemia in observational studies but not RCTs (0.25 versus 1.00). Network meta-analyses suggest that incretin mimetics can reduce the risk of hypoglycemia by nearly 1.5 times.The newer antidiabetic agents appear to lower the risk of hypoglycemia and improved glycemic control when compared with sulfonylureas. Ramadan-focused education shows to be a promising strategy but more rigorous examination from RCTs are required.

Conflict of interest statement

Competing Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from corresponding author).

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Flow diagram depicts article selection process.
FIGURE 2
FIGURE 2
Summary estimates from the network meta-analysis on risk of hypoglycemia in patients fasting during Ramadan using different pharmacological agents. CrI = credible interval.

References

    1. The Global Religious Landscape: A Report on the Size and Distribution of the World's Major Religious Groups as of 2010. Washington, DC: Pew Research Center; 2012.
    1. Salti I, Benard E, Detournay B, et al. A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diabetes Care 2004; 27:2306–2311.
    1. Beshyah S, Benbarka M, Sherif I. Practical management of diabetes during Ramadan fast. Libyan J Med 2007; 2:185–189.
    1. Abrams KR, Gillies CL, Lambert PC. Meta-analysis of heterogeneously reported trials assessing change from baseline. Stat Med 2005; 24:3823–3844.
    1. White IR, Barrett JK, Jackson D, et al. Consistency and inconsistency in network meta-analysis: model estimation using multivariate meta-regression. Res Synth Methods 2012; 3:111–125.
    1. Chaimani A, Higgins JPT, Mavridis D, et al. Graphical tools for network meta-analysis in STATA. PLoS One 2013; 8:e76654.
    1. Weiss J. Fasting in Ramadan despite chronic diseases. Dtsch Med Wochenschr 2009; 134:29–30.
    1. Katibi I, Akande A, Bojuwoye B, et al. Blood sugar control among fasting Muslims with type 2 diabetes mellitus in Ilorin. Niger J Med 2001; 10:132–134.
    1. Al Sifri S, Basiounny A, Echtay A, et al. The incidence of hypoglycaemia in Muslim patients with type 2 diabetes treated with sitagliptin or a sulphonylurea during Ramadan: a randomised trial. Int J Clin Pract 2011; 65:1132–1140.
    1. Al-Arouj M, Hassoun AAK, Medlej R, et al. The effect of vildagliptin relative to sulphonylureas in Muslim patients with type 2 diabetes fasting during Ramadan: the VIRTUE study. Int J Clin Pract 2013; 67:957–963.
    1. Anwar A, Azmi KN, Hamidon BB, et al. An open label comparative study of glimepiride versus repaglinide in type 2 diabetes mellitus Muslim subjects during the month of Ramadan. Med J Malaysia 2006; 61:28–35.
    1. Aravind SR, Ismail SB, Balamurugan R, et al. Hypoglycemia in patients with type 2 diabetes from India and Malaysia treated with sitagliptin or a sulfonylurea during Ramadan: a randomized, pragmatic study. Curr Med Res Opin 2012; 28:1289–1296.
    1. Bakiner O, Ertorer M, Bozkirli E, et al. Repaglinide plus single-dose insulin glargine: a safe regimen for low-risk type 2 diabetic patients who insist on fasting in Ramadan. Acta Diabetol 2009; 46:63–65.
    1. Belkhadir J, Ghomari HE, Klöcker N, et al. Muslims with non-insulin dependent diabetes fasting during Ramadan: treatment with glibenclamide. Br Med J 1993; 307:292–294.
    1. Brady EM, Davies MJ, Gray LJ, et al. A randomized controlled trial comparing the GLP-1 receptor agonist liraglutide to a sulphonylurea as add on to metformin in patients with established type 2 diabetes during Ramadan: the Treat 4 Ramadan Trial. Diabetes Obes Metab 2014; 16:527–536.
    1. Cesur M, Corapcioglu D, Gursoy A, et al. A comparison of glycemic effects of glimepiride, repaglinide, and insulin glargine in type 2 diabetes mellitus during Ramadan fasting. Diabetes Res Clin Pract 2006; 75:141–147.
    1. Devendra D, Gohel B, Bravis V, et al. Vildagliptin therapy and hypoglycaemia in Muslim type 2 diabetes patients during Ramadan. Int J Clin Pract 2009; 63:1446–1450.
    1. Halimi S, Levy M, Huet D, et al. Experience with vildagliptin in type 2 diabetic patients fasting during Ramadan in France: insights from the VERDI study. Diabetes Ther 2013; 4:385–398.
    1. Hassanein M, Abdallah K, Schweizer A. A double-blind, randomized trial, including frequent patient-physician contacts and Ramadan-focused advice, assessing vildagliptin and gliclazide in patients with type 2 diabetes fasting during Ramadan: the STEADFAST study. Vasc Health Risk Manag 2014; 10:319–326.
    1. Hassanein M, Hanif W, Malik W, et al. Comparison of the dipeptidyl peptidase-4 inhibitor vildagliptin and the sulphonylurea gliclazide in combination with metformin, in Muslim patients with type 2 diabetes mellitus fasting during Ramadan: results of the VECTOR study. Curr Med Res Opin 2011; 27:1367–1374.
    1. Mafauzy M. Repaglinide versus glibenclamide treatment of type 2 diabetes during Ramadan fasting. Diabetes Res Clin Pract 2002; 58:45–53.
    1. Malha LP, Taan G, Zantout MS, et al. Glycemic effects of vildagliptin in patients with type 2 diabetes before, during and after the period of fasting in Ramadan. Ther Adv Endocrinol Metab 2014; 5:3–9.
    1. Salti I. Diabetes and Ramadan Study Group. Efficacy and safety of insulin glargine and glimepiride in subjects with Type 2 diabetes before, during and after the period of fasting in Ramadan. Diabet Med 2009; 26:1255–1261.
    1. Sari R, Balci M, Akbas S, et al. The effects of diet, sulfonylurea, and repaglinide therapy on clinical and metabolic parameters in type 2 diabetic patients during Ramadan. Endocr Res 2004; 30:169–177.
    1. Shete A, Shaikh A, Nayeem K, et al. Vildagliptin vs sulfonylurea in Indian Muslim diabetes patients fasting during Ramadan. World J Diabetes 2013; 4:358–364.
    1. Vasan S, Thomas N, Bharani, et al. A double-blind, randomized, multicenter study evaluating the effects of pioglitazone in fasting Muslim subjects during Ramadan. Int J Diabetes Dev C 2006; 26:70.
    1. Akram J, De Verga V. Insulin lispro (Lys(B28), Pro(B29) in the treatment of diabetes during the fasting month of Ramadan. Ramadan Study Group. Diabet Med 1999; 16:861–866.
    1. Hui E, Bravis V, Salih S, et al. Comparison of Humalog Mix50 with human insulin Mix30 in type 2 diabetes patients during Ramadan. Int J Clin Pract 2010; 64:1095–1099.
    1. Mattoo V, Milicevic Z, Malone JK, et al. A comparison of insulin lispro Mix25 and human insulin 30/70 in the treatment of type 2 diabetes during Ramadan. Diabetes Res Clin Pract 2003; 59:137–143.
    1. Mustafa HE, Hashim T, Beshyah SA, et al. The effect of “Targeted Diabetes Education” on glycemic control during Ramadan fasting. Ibnosina J Med BS 2012; 4:242–248.
    1. Prataksitorn C, Singchungchai P. The effective of Ramadan focused education on awareness and glycemic control of diabetic Muslims (Type 2 diabets) during Ramadan fasting. Int J Public Health Res 2014; 4:405–411.
    1. Susilparat P, Pattaraarchachai J, Songchitsomboon S, et al. Effectiveness of contextual education for self-management in Thai Muslims with type 2 diabetes mellitus during Ramadan. J Med Assoc Thai 2014; 97:S41–S49.
    1. McEwen LN, Ibrahim M, Ali NM, et al. Impact of an individualized type 2 diabetes education program on clinical outcomes during Ramadan. Br Med J Open Diab Res Care 2015; 3:e000111.
    1. Wangthong A, Cheyoe N. Effects of diabetic drug adjustment among fasting diabetic patients during the Ramadan period in Nongjik District, Pattani Province. J Health Syst Res 2008; 2:130–135.
    1. Shehadeh N, Maor Y. the Ramadan Study G. Effect of a new insulin treatment regimen on glycaemic control and quality of life of Muslim patients with type 2 diabetes mellitus during Ramadan fast: an open label, controlled, multicentre, cluster randomised study. Int J Clin Pract 2015; 69:1281–1288.
    1. Norouzy A, Mohajeri S, Shakeri S, et al. Effect of Ramadan fasting on glycemic control in patients with type 2 diabetes. J Endocrinol Invest 2012; 35:766–771.
    1. Lee JY, Lee SWH, Nasir NH, et al. Diabetes telemonitoring reduces the risk of hypoglycaemia during Ramadan: a pilot randomized controlled study. Diabetic Med 2015; 32:1658–1661.
    1. Al-Arouj M, Bouguerra R, Buse J, et al. Recommendations for management of diabetes during Ramadan. Diabetes Care 2005; 28:2305–2311.
    1. Global guideline for type 2 diabetes. Diabetes Res Clin Pract 2014; 104:1–52.
    1. Ibrahim M, Abu Al Magd M, Annabi FA, et al. Recommendations for management of diabetes during Ramadan: update 2015. Br Med J Open Diabetes Res Care 2015; 3:e000108.
    1. Karagiannis T, Paschos P, Paletas K, et al. Dipeptidyl peptidase-4 inhibitors for treatment of type 2 diabetes mellitus in the clinical setting: systematic review and meta-analysis. Br Med J 2012; 344:e1369.
    1. Aroda VR, Ratner R. The safety and tolerability of GLP-1 receptor agonists in the treatment of type 2 diabetes: a review. Diabetes Metab Res Rev 2011; 27:528–542.
    1. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352:837–853.
    1. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998; 352:854–865.
    1. Gary TL, Genkinger JM, Guallar E, et al. Meta-analysis of randomized educational and behavioral interventions in type 2 diabetes. Diabetes Educ 2003; 29:488–501.
    1. Gray LJ, Dales J, Brady EM, et al. Safety and effectiveness of non-insulin glucose-lowering agents in the treatment of people with type 2 diabetes who observe Ramadan: a systematic review and meta-analysis. Diabetes Obes Metab 2015; 17:639–648.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel