Incidence of hypoglycemia in patients with type 2 diabetes treated with gliclazide versus DPP-4 inhibitors during Ramadan: A meta-analytical approach


      • Individualized Ramadan-focused advice minimizes risk of hypoglycemic events (HEs).
      • Patients taking a DPP-4i or gliclazide when fasting during Ramadan have similarly low risks of HEs.
      • Randomized-controlled studies are needed to assess OADs and incidence of HEs during Ramadan.



      Hypoglycemia can be a concern for patients with type 2 diabetes when fasting during Ramadan. In this analysis, we assessed the incidence of symptomatic hypoglycemic events in fasting patients treated with gliclazide or dipeptidyl peptidase-4 (DPP-4) inhibitors.


      A systematic literature review was performed to identify randomized clinical trials comparing the efficacy and safety of gliclazide with DPP-4 inhibitors when treating adults with type 2 diabetes fasting during Ramadan. The primary endpoint of all included studies was the incidence of symptomatic hypoglycemic events.


      The pooled analysis included three randomized trials. There was no evidence of heterogeneity between the studies (I2 = 0%). There was no significant difference in the incidence of symptomatic hypoglycemic events in patients fasting during Ramadan treated with either a DPP-4 inhibitor or gliclazide (5.6% versus 7.2%, risk ratio 1.12, 95% CI 0.73–1.73, p = 0.61).


      Patients treated with either gliclazide or DPP-4 inhibitors while fasting during Ramadan have similarly low risks of experiencing symptomatic hypoglycemia. Gliclazide is an effective oral antidiabetic that may be suitable for the management of patients with type 2 diabetes during Ramadan. Individualized Ramadan-focused advice and evening intake of treatment may improve the management of patients with diabetes during Ramadan.


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