title: Vildagliptin therapy and hypoglycaemia in Muslim type 2 diabetes patients during Ramadan.
abstract: OBJECTIVE
  To compare hypoglycaemic events, glycated haemoglobin (HbA(1c)) and changes in bodyweight in metformin-treated Muslim patients with type 2 diabetes receiving adjunctive treatment with vildagliptin or gliclazide during Ramadan fasting.
  
  
  METHODS
  Data were collected from Muslim patients with type 2 diabetes attending primary care practices in North West London, whose HbA(1c) was > 8.5% despite treatment with metformin 2 g daily before Ramadan and who received gliclazide 160 mg twice daily (n = 26) or vildagliptin 50 mg twice daily (n = 26) in addition to metformin. Hypoglycaemic events, HbA(1c) and weight were recorded 2 weeks before and 10 days after the Ramadan fast. All patients received education about how to identify and manage hypoglycaemia during Ramadan.
  
  
  RESULTS
  During Ramadan, at least one hypoglycaemic event (defined as blood glucose < 3.5 mmol/l with or without symptoms) was recorded in two patients receiving vildagliptin (7.7%) and 16 patients receiving gliclazide [61.5%; difference between groups -53.8%, 95% confidence interval (CI) -74.9 to -26.3, p < 0.001]. Vildagliptin was associated with a reduction in the mean number of hypoglycaemic events during Ramadan compared with before Ramadan, whereas gliclazide was associated with an increase (least squares mean difference between groups -0.66, 95% CI -1.20 to -0.13, p = 0.0168). Both gliclazide and vildagliptin were associated with similar reductions in HbA(1c) and a small, but insignificant, increase in weight.
  
  
  CONCLUSIONS
  Appropriate treatment adjustments can lead to improved diabetes management during Ramadan, with avoidance of significant weight gain and improved glucose control without hypoglycaemia. The addition of vildagliptin to metformin therapy during Ramadan in Muslim patients with type 2 diabetes was associated with a reduction in the incidence of hypoglycaemia.
authors.affiliation: NHS Brent, London, UK. d.devendra@imperial.ac.uk
authors.forename: D
authors.initials: D
authors.lastname: Devendra
authors.forename: B
authors.initials: B
authors.lastname: Gohel
authors.forename: V
authors.initials: V
authors.lastname: Bravis
authors.forename: E
authors.initials: E
authors.lastname: Hui
authors.forename: S
authors.initials: S
authors.lastname: Salih
authors.forename: S
authors.initials: S
authors.lastname: Mehar
authors.forename: M
authors.initials: M
authors.lastname: Hassanein
mesh_terms: D000218:Adamantane / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000208:ethnology; D004359:Drug Therapy, Combination; D005215:Fasting / Q000097:blood; D005260:Female; D005907:Gliclazide / Q000008:administration & dosage; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007514:Islam; D008297:Male; D008687:Metformin / Q000008:administration & dosage; D008875:Middle Aged; D009570:Nitriles / Q000008:administration & dosage*; D011759:Pyrrolidines / Q000008:administration & dosage*; D016896:Treatment Outcome; D000077597:Vildagliptin
chemical_list: D000218:Adamantane; D001786:Blood Glucose; D005907:Gliclazide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008687:Metformin; D009570:Nitriles; D011759:Pyrrolidines; D000077597:Vildagliptin