title: Hypoglycaemia in sulphonylurea-treated subjects with type 2 diabetes undergoing Ramadan fasting: a five-country observational study.
abstract: OBJECTIVE
  To determine the incidence of hypoglycaemia during Ramadan in Muslim subjects with type 2 diabetes treated with a sulphonylurea.
  
  
  METHODS
  In an observational study, eligible subjects were Muslims with type 2 diabetes (age ≥18 years) who were treated with glimepiride, gliclazide, or glibenclamide with or without metformin and who expressed their intention to fast during Ramadan in 2009. Subjects were recruited by clinicians in India, Malaysia, Israel, the United Arab Emirates (UAE), and Saudi Arabia. Each day during Ramadan, patients completed diary cards, which collected information regarding hypoglycaemic symptoms and complications, time from last meal and from last medication, self-monitored blood glucose measurements, and need for assistance. The overall incidence of symptomatic hypoglycaemia recorded during Ramadan was the primary endpoint of interest.
  
  
  RESULTS
  Of the enrolled subjects (N = 1397), 1378 returned their diary cards at study end and were included in the analysis. Overall, 89% of subjects who expressed their intention to fast prior to Ramadan reported that they observed the fast during Ramadan. A total of 271 subjects (19.7%) experienced one or more symptomatic hypoglycaemic events during Ramadan, with incidences of 25.6%, 16.8%, and 14.0% observed in subjects treated with glibenclamide, glimepiride, and gliclazide, respectively. By country, the highest incidence of hypoglycaemia was reported by subjects from Israel (40%) followed by those from Malaysia (24%), the UAE (18%), India (13%), and Saudi Arabia (10%). The overall incidence of severe hypoglycaemic events (i.e., events requiring medical or non-medical assistance) was 6.7%, with the highest incidence occurring in the glibenclamide group.
  
  
  CONCLUSIONS
  This was an observational study and as such subjects were not randomised to treatments. While baseline measures appeared comparable, it is possible that differences in measured and unmeasured patient characteristics (e.g., measures of glycaemic control) could partially explain these results. Lastly, no inferential testing was performed on the comparisons between sulphonylurea types and/or countries.
  
  
  CONCLUSIONS
  In this five-country observational study, nearly 20% of sulphonylurea-treated Muslim subjects with type 2 diabetes experienced symptomatic hypoglycaemia while fasting during Ramadan, with variations across sulphonylureas and countries.
authors.affiliation: Diacon Hospital, Diabetes Care & Research Centre, Bangalore, India. draravind@hotmail.com
authors.forename: S R
authors.initials: SR
authors.lastname: Aravind
authors.forename: Khaled
authors.initials: K
authors.lastname: Al Tayeb
authors.forename: Shaiful Bahari
authors.initials: SB
authors.lastname: Ismail
authors.forename: Naim
authors.initials: N
authors.lastname: Shehadeh
authors.forename: Ghaida
authors.initials: G
authors.lastname: Kaddaha
authors.forename: Rose
authors.initials: R
authors.lastname: Liu
authors.forename: Robert
authors.initials: R
authors.lastname: Balshaw
authors.forename: Nadia
authors.initials: N
authors.lastname: Lesnikova
authors.forename: Olaf
authors.initials: O
authors.lastname: Heisel
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Girman
authors.forename: Bret J
authors.initials: BJ
authors.lastname: Musser
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Davies
authors.forename: Harvey L
authors.initials: HL
authors.lastname: Katzeff
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Engel
authors.forename: Larry
authors.initials: L
authors.lastname: Radican
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D005215:Fasting; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000150:complications*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007514:Islam; D008297:Male; D008875:Middle Aged; D013453:Sulfonylurea Compounds / Q000627:therapeutic use*
chemical_list: D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds