title: Comparative studies of dipeptidyl peptidase 4 inhibitor vs sulphonylurea among Muslim Type 2 diabetes patients who fast in the month of Ramadan: A systematic review and meta-analysis.
abstract: OBJECTIVE
  To systematically review the literature to compare the use of DPP4 inhibitors vs sulphonylurea in type 2 diabetic Muslim patients who fast in Ramadan, with regards to its safety, tolerability, glycemic control, and body weight changes.
  
  
  METHODS
  All English-language medical literature published from inception till October 2014 which met the inclusion criteria were reviewed and analyzed.
  
  
  RESULTS
  A total of nine papers were included, reviewed and analyzed. The total sample size was 4276 patients. All studies used either of the two DPP4 inhibitors - Vildagliptin or Sitagliptin, vs sulphonylurea or meglitinides. Patients receiving DPP4 inhibitors were less likely to develop symptomatic hypoglycemia (risk ratio 0.46; 95% CI, 0.30-0.70), confirmed hypoglycemia (risk ratio 0.36; 95% CI, 0.21-0.64) and severe hypoglycemia (risk ratio 0.22; 95% CI, 0.10-0.53) compared with patients on sulphonylureas. There was no statistically significant difference in HbA1C changes comparing Vildagliptin and sulphonylurea.
  
  
  CONCLUSIONS
  DPP4 inhibitor is a safer alternative to sulphonylurea in Muslim patients with type 2 diabetes mellitus who fast during the month of Ramadan as it is associated with lower risk of symptomatic, confirmed and severe hypoglycemia, with efficacy comparable to sulphonylurea.
authors.affiliation: Faculty of Medicine and Health Sciences, University of Malaysia Sarawak, Jalan Datuk Mohd Musa, 94300 Kota Samarahan, Sarawak, Malaysia. Electronic address: hh_loh@yahoo.com.my.
authors.forename: Huai Heng
authors.initials: HH
authors.lastname: Loh
authors.affiliation: Department of Psychological Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
authors.forename: Anne
authors.initials: A
authors.lastname: Yee
authors.affiliation: Clinical Academic Unit, Newcastle University Medicine Malaysia, No. 1, Jalan Sarjana 1, Kota Ilmu, Educity@Iskandar, 79200 Nusajaya, Johor, Malaysia.
authors.forename: Huai Seng
authors.initials: HS
authors.lastname: Loh
authors.affiliation: Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, Malaysia.
authors.forename: Norlela
authors.initials: N
authors.lastname: Sukor
authors.affiliation: Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, Malaysia.
authors.forename: Nor Azmi
authors.initials: NA
authors.lastname: Kamaruddin
mesh_terms: D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D018819:Dipeptidyl Peptidase 4 / Q000378:metabolism*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D005215:Fasting / Q000097:blood*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007514:Islam / Q000523:psychology; D016017:Odds Ratio; D061214:Patient Safety; D012068:Religion and Medicine; D018570:Risk Assessment; D012307:Risk Factors; D013453:Sulfonylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D018819:Dipeptidyl Peptidase 4; D054873:Dipeptidyl-Peptidase IV Inhibitors; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; C517652:hemoglobin A1c protein, human; C042807:DPP4 protein, human
keywords: Dipeptidyl peptidase-4 inhibitor; Ramadan fasting; Sulphonylurea; Type 2 diabetes mellitus