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

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.