The Safety of Continuing Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor during Ramadan Fasting in Muslim Patients with Type 2 Diabetes

Methods: This is a single-centre, prospective observational controlled cohort study. Muslim patients aged 18 to 75 years with type 2 diabetes and estimated glomerular rate (eGFR) ≥ 45 ml/min/1.73 m2 were eligible if they had no contraindication to observe Ramadan fasting. Patients in study group received stable dose of SGLT2 Inhibitor for ≥ 3 months prior to enrolment and during study period, while patients in control group were not on SGLT2 inhibitor before and during study period. All participants were to attend baseline visit within 2 months before Ramadan and follow-up visit during Ramadan. Results: A total of 68 patients of similar baseline characteristics were included in the study: 35 in study group and 33 in control group. During Ramadan fasting, patients from study and control group had similar change in weight (LS mean change of -1.8 vs. -1.1kg, p=0.205), eGFR (LS mean change of -6.0 vs. -4.2ml/min/1.73m2; p= 0.399), sitting systolic BP (LS mean change of - 8.0 vs. -10.4mmHg, p=0.569), sitting diastolic BP (LS mean change of -3.7 vs. - 3.5mmHg, p=0.934) and plasma β-hydroxybutyrate level (LS mean change of -0.01 vs. -0.02mmol/L, p=0.649). Conclusions: Continued use of SGLT2 Inhibitors during Ramadan in the study had no increased risk in eGFR deterioration, ketonemia, hypoglycaemia and postural hypotension.