title: Incidence of hypoglycemia in patients with type 2 diabetes treated with gliclazide versus DPP-4 inhibitors during Ramadan: A meta-analytical approach.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  The pooled analysis included three randomized trials. There was no evidence of heterogeneity between the studies (I(2)=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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Yaounde I, Cameroon; Endocrinology and Metabolic Diseases Unit at the Hospital Central in Yaounde, Cameroon. Electronic address: jcmbanya@yahoo.co.uk.
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Mbanya
authors.affiliation: Endocrinology Department, Al Hada Military Hospital, Taif, Saudi Arabia.
authors.forename: Saud
authors.initials: S
authors.lastname: Al-Sifri
authors.affiliation: Faculty of Medicine, Alexandria University, Egypt.
authors.forename: Aly
authors.initials: A
authors.lastname: Abdel-Rahim
authors.affiliation: Division of Endocrinology and Metabolic Disease, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Ilhan
authors.initials: I
authors.lastname: Satman
mesh_terms: D001786:Blood Glucose / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000523:psychology; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D005215:Fasting; D005907:Gliclazide / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D007514:Islam
chemical_list: D001786:Blood Glucose; D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; D005907:Gliclazide
keywords: Diabetes; Gliclazide; Ramadan