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Abdallah M. Beano  (Beano AM) 1 Article
Predetermined Anti-Diabetic Drug Regimen Adjustments during Ramadan Fasting: An Observational Study of Safety
Abdallah M. Beano, Mohammad A. Zmaili, Zaid H. Gheith, Ahmad M. Naser, Munther S. Momani, Al-Motassem F. Yousef, Ayman A. Zayed
Endocrinol Metab. 2017;32(2):265-273.   Published online June 23, 2017
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  • 9 Citations
AbstractAbstract PDFPubReader   CrossRef-TDMCrossref - TDM

Many Muslim type 2 diabetes mellitus (T2DM) patients choose to fast the month of Ramadan despite the possible adverse health effects brought about by the change in dietary habits, among other things. Clinical data regarding the safety of multi-drug regimens during fasting are particularly scarce. The aim of the study was to evaluate the safety of a drug protocol devised by the authors to accommodate Ramadan's dietary changes, involving dose adjustments of four anti-diabetic drug regimens in T2DM patients fasting Ramadan.


In this prospective, observational, open-label study, 301 T2DM patients who wished to fast Ramadan were followed during Ramadan and the preceding month. The incidence of hypoglycemia, diabetic ketoacidosis (DKA) and non-ketotic hyperosmolar state (NKHS) was monitored. Patients were classified into four groups: A group (those taking metformin, sulfonylurea and insulin [n=33]); B group (metformin and sulfonylurea [n=89]); C group (metformin and insulin [n=96]); and D group (premixed 70/30, glargine or regular insulin [n=82]). During Ramadan, drug doses were adjusted as percentages of their pre-Ramadan values: 75% for sulfonylureas, 75% for glargine, 75% for premixed insulin 70/30 in two doses, and 75% for regular insulin. Metformin was adjusted to a twice-daily regimen.


No cases of DKA or NKHS were reported. Hypoglycemia occurred at a lower rate than pre-Ramadan values in groups C, and D; and a similar rate in groups A, and B.


The data suggested that using the above protocol to adjust the doses of anti-diabetic drugs is safe in T2DM patients in regards to hypoglycemia, DKA, and NKHS.


Citations to this article as recorded by  
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  • Evidence-based risk factors for major complications during Ramadan fasting in people with diabetes grouped under IDF-DAR risk categories
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  • Effect of Dosage Reduction of Hypoglycemic Multidrug Regimens on the Incidences of Acute Glycemic Complications in People With Type 2 Diabetes Who Fast During Ramaḍān: A Randomized Controlled Trial
    Louay Y. Zaghlol, Amir F. Beirat, Justin Z. Amarin, Amro M. Hassoun Al Najar, Yazan Y. Hasan, Abdallah Qtaishat, Michael E. Tierney, Raja Y. Zaghlol, Ayman A. Zayed
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  • Recommendations for management of diabetes during Ramadan: update 2020, applying the principles of the ADA/EASD consensus
    Mahmoud Ibrahim, Melanie J Davies, Ehtasham Ahmad, Firas A Annabi, Robert H Eckel, Ebtesam M Ba-Essa, Nuha Ali El Sayed, Amy Hess Fischl, Pamela Houeiss, Hinde Iraqi, Ines Khochtali, Kamlesh Khunti, Shabeen Naz Masood, Safia Mimouni-Zerguini, Samad Shera,
    BMJ Open Diabetes Research & Care.2020; 8(1): e001248.     CrossRef
  • Ramadan and Diabetes: A Narrative Review and Practice Update
    Syed H. Ahmed, Tahseen A. Chowdhury, Sufyan Hussain, Ateeq Syed, Ali Karamat, Ahmed Helmy, Salman Waqar, Samina Ali, Ammarah Dabhad, Susan T. Seal, Anna Hodgkinson, Shazli Azmi, Nazim Ghouri
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  • A systematic review on efficacy and safety of the current hypoglycemic agents in patients with diabetes during Ramadan fasting
    Fauzia Rashid, Elamin Abdelgadir
    Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2019; 13(2): 1413.     CrossRef
  • Risk of diabetic ketoacidosis during Ramadan fasting: A critical reappraisal
    Salem A. Beshyah, Tahseen A. Chowdhury, Nazim Ghouri, Abdulfattah A. Lakhdar
    Diabetes Research and Clinical Practice.2019; 151: 290.     CrossRef

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