380-P: Safety of SGLT2 Inhibitors in People with Diabetes With or Without Background Insulin-Data from DAR Global Survey

Introduction: A considerable number of studies have assessed the safety of Ramadan fasting in people with diabetes mellitus. This global survey from various region in the middle east and north Africa is tailored to fill further gaps in safety of SGLT2i during Ramadan fasting. Methods: The participating countries from 5 geographical regions were as follows: Southeast Asia, Gulf nations, Maghreb countries, Middle East and Turkey. All participating physicians interviewed people with diabetes who intended to fast Ramadan, the biometric and biochemical data was extracted from the electronic medical files Results: The overall survey population was 5865 people with T2D on oral injectable. Out of those patients 2379 were on SGLT2i plus other hypoglycaemic agents. 705 were on GLT2i without Sulfonylurea (SU) or insulin, 927 were on SGLT2i and insulin but without SU, and 169 patients were on combination of theSGLT2i, SU, and insulin. Only 5.4 % did break their fast in the SGLT2i group compared to 13.6% in the triple combination. Hypoglycemia was least encountered in the SGLT2i (8%), 16.4% in the dual combination, and 20.9% in the triple combination therapy. Majority of hypoglycemia episodes were between 3 pm and Maghrib time (estimated 6-8 PM) in the SGLT2i group (72.5%), while in the group with insulin and/or SU had hypoglycemia predominance from 12 mid-day till maghrib. In terms of emergency room attendance due to hypoglycemia doubled when insulin was added and increased to 3.5 folds when both insulin and SU was added to SGLT2i (3.4 and 6.9%, respectively compared to 1.9% in the SGLT2i group). Conclusion: In this study, SGLT2i without insulin and/or SU is associated with less hypoglycemia, less days with broken fasting due to diabetes related complications. The emergency room attendance increased up to 3.5 folds when Insulin and/or SU to SGLT2i.