Sodium-Glucose Cotransporter 2 (SGLT-2) Inhibitor drugs: Assessment of safety in Fasting Diabetics

  • Muhammad Imran Hasan Khan Ameer ud Din Medical College / PGMI, Lahore
  • Salman Shakeel
  • Usama Azhar
  • Aqsa Javaid
  • Faiqa Ijaz Khan
Keywords: Safety, Fasting, Hypoglycemia, SU, Sodium-Glucose Co-transporter.


Introduction: Ramadan is a holy month and the majority of Muslims fast in it, without considering background illnesses. SGLT-2 drugs were available for Pakistani patients recently, and this was the first year to fast in their presence.
Objectives: To assess the risk of hypoglycemia in fasting diabetics using SGLT-2 drugs, comparing it with Sulphonylurea (SU) drugs. Also, a change in HbA1c and eGFR was checked. Hence, evidence was collected to recommend their use in fasting Diabetics with safety.
Material and Methods: A total of 5500 patients from three different sites were included. Only 500 fulfilled the criteria of inclusion. Pregnant, lactating, advanced Chronic Kidney Disease (CKD), and those recording hypoglycemia frequently were not included. Ages between 20 to 70 years, HbA1c between 7 to 11, and patients taking SU or SGLT-2 were included.
Conclusion: The eGFR was comparable in both groups post-Ramadan. HbA1c was significantly reduced in the SGLT-2 group. Bitter taste and thirst were common with the SU group. Hypoglycemia was comparable in both groups. We concluded that SGLT-2 drugs were safe during Ramadan, and caused more HbA1c reduction.


1. Lessan N, Ali T. Energy Metabolism and Intermittent Fasting: The Ramadan Perspective. Nutrients. 2019 May 27;11(5).
2. Raza SA, Aamir AH, Jawa A, Qureshi FM, Ahmad I, Khan KM, et al. Expert Opinion: Use of sodium glucose co-transporter type-2 inhibitors in South Asian population -The Pakistan perspective. J Pak Med Assoc. 2019 Apr;69(4):555–63.
3. Mudher Mikhael E. Effectiveness and Safety of Newer Antidiabetic Medications for Ramadan Fasting Diabetic Patients. J Diabetes Res. 2016;2016:6962574.
4. Salti I, Bénard E, Detournay B, Bianchi-Biscay M, Brigand CL, Voinet C, et al. A Population-Based Study of Diabetes and Its Characteristics During the Fasting Month of Ramadan in 13 Countries: Results of the Epidemiology of Diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diabetes Care. 2004 Oct 1;27(10):2306–11.
5. Hassanein M, Hanif W, Malik W, Kamal A, Geransar P, Lister N, et al. Comparison of the dipeptidyl peptidase-4 inhibitor vildagliptin and the sulphonylurea gliclazide in combination with metformin, in Muslim patients with type 2 diabetes mellitus fasting during Ramadan: results of the VECTOR study. Current Medical Research and Opinion. 2011 Jul 1;27(7):1367–74.
6. The effect of Ramadan fasting and continuing sodium-glucose co-transporter-2 (SGLT2) inhibitor use on ketonemia, blood pressure and renal function in Muslim patients with type 2 diabetes - Diabetes Research and Clinical Practice [Internet]. [cited 2019 May 15]. Available from:
7. Safety of Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2-I) During the Month of Ramadan in Muslim Patients with Type 2 Diabetes [Internet]. [cited 2019 May 15]. Available from:
8. Switching from sulphonylurea to a sodium‐glucose cotransporter2 inhibitor in the fasting month of Ramadan is associated with a reduction in hypoglycaemia - Wan Seman - 2016 - Diabetes, Obesity and Metabolism - Wiley Online Library [Internet]. [cited 2019 May 15]. Available from:
9. Hassanein M, Al-Arouj M, Hamdy O, Bebakar WMW, Jabbar A, Al-Madani A, et al. Diabetes and Ramadan: Practical guidelines. Diabetes Res Clin Pract. 2017 Apr;126:303–16.
10. Bener A, Al-Hamaq AOAA, Öztürk M, Çatan F, Haris PI, Rajput KU, et al. Effect of Ramadan Fasting on Glycemic Control and other Essential Variables in Diabetic Patients. Ann Afr Med. 2018;17(4):196–202.
11. Aydın N, Kul S, Karadağ G, Tabur S, Araz M. Effect of Ramadan fasting on glycaemic parameters & body mass index in type II diabetic patients: A meta-analysis. Indian J Med Res. 2019 Dec;150(6):546–56.
12. Shao Y, Lim GJ, Chua CL, Wong YF, Yeoh ECK, Low SKM, et al. The effect of Ramadan fasting and continuing sodium-glucose co-transporter-2 (SGLT2) inhibitor use on ketonemia, blood pressure and renal function in Muslim patients with type 2 diabetes. Diabetes Res Clin Pract. 2018 Aug;142:85–91.
13. Almalki MH, Alshahrani F. Options for Controlling Type 2 Diabetes during Ramadan. Front Endocrinol (Lausanne) [Internet]. 2016 Apr 18 [cited 2020 Aug 22];7. Available from:
14. Raveendran AV, Zargar AH. Diabetes control during Ramadan fasting. CCJM. 2017 May 1;84(5):352–6.
15. Mansouri D, Khayat E, Khayat M, Aboawja M, Aseeri A, Banah F, et al. Self-Monitoring of Blood Glucose and Hypoglycemia Association During Fasting in Ramadan Among Patients with Diabetes. Diabetes Metab Syndr Obes. 2020 Apr 5;13:1035–41.
16. Aldawi N, Darwiche G, Abusnana S, Elbagir M, Elgzyri T. Initial increase in glucose variability during Ramadan fasting in non-insulin-treated patients with diabetes type 2 using continuous glucose monitoring. Libyan J Med [Internet]. 2018 Oct 22 [cited 2020 Aug 25];14(1). Available from:
17. Lee JY, Wong CP, Tan CSS, Nasir NH, Lee SWH. Telemonitoring in fasting individuals with Type 2 Diabetes Mellitus during Ramadan: A prospective, randomised controlled study. Sci Rep [Internet]. 2017 Aug 31 [cited 2020 Aug 25];7. Available from:
18. Hassanein M, Echtay AS, Malek R, Omar M, Shaikh SS, Ekelund M, et al. Original paper: Efficacy and safety analysis of insulin degludec/insulin aspart compared with biphasic insulin aspart 30: A phase 3, multicentre, international, open-label, randomised, treat-to-target trial in patients with type 2 diabetes fasting during Ramadan. Diabetes Research and Clinical Practice. 2018 Jan 1;135:218–26.
19. Badshah A, Haider I, Humayun M. MANAGEMENT OF DIABETES IN RAMADAN. Journal of Ayub Medical College Abbottabad. 2018 Nov 26;30(4):592–8.
20. Elhadd T, Dabbous Z, Bashir M, Elzouki A, Ghadban W, Baagar K, et al. Incidence of hypoglycaemia in patients with type-2 diabetes taking multiple glucose lowering therapies during Ramadan: the PROFAST Ramadan Study. J Diabetes Metab Disord. 2018 Nov 19;17(2):309–14.
How to Cite
Khan MIH, Shakeel S, Azhar U, Javaid A, Khan F. Sodium-Glucose Cotransporter 2 (SGLT-2) Inhibitor drugs: Assessment of safety in Fasting Diabetics. JRMC [Internet]. 30Mar.2021 [cited 23May2022];25(1):53-9. Available from:

Most read articles by the same author(s)