International Expert Collaborates with Local Doctors and Health Societies across the GCC to Help Advise Fasting Muslim Patients during the Holy Month
Study into Fasting Shows Taking Metformin with Galvus (vildagliptin) Reduces Hypoglycaemic Events in those with Type 2 Diabetes
Kuwait City, Kuwait: Taking the proper combination of diabetes medications while fasting during Ramadan can significantly reduce the risk of those with type 2 diabetes suffering a hypoglycaemic event - where blood sugar becomes dangerously low according to a recent study (1).
The UK research, published in Current Medical Research and Opinion, investigated the effects of different treatments on diabetes control in 72 Muslims with type 2 diabetes, who were fasting for 11-20 hours per day during the holy month of Ramadan.
The study found that those taking metformin in combination with Galvus (vildagliptin) experienced no hypoglycemic episodes during the 16 week study, compared with those who took metformin and sulphonylurea of which more than 40 percent suffered such an event.
To promote increased awareness amongst health care practitioners and patients on the importance of blood sugar control during the holy month, the study's author Dr Mohamed Hassanein, Diabetes and Endocrinology Consultant and Honorary Senior Lecturer at Cardiff University in the UK, has embarked on a speaker tour across the Gulf, landing in Kuwait on 25 June to collaborate with local health authorities.
The workshop aimed to discuss the needs of the local Muslim community, collaborating on the difficult task of advising diabetic patients on the safety of fasting, as well as recommending the dietary and drug regimens that diabetics should follow if they decide to fast.
"Fasting in Ramadan is a great passion for Muslims and that includes those with diabetes. The problem is that they can experience very high or very low blood sugar levels during the month, especially after breaking their fast," said Dr. Hassanein.
"The results from the study show that fasting Muslim patients are able to fulfil their religious obligation without risk of harming themselves - which is important as sometimes the passion of the patient overrides the advice from their doctor, despite certain high risk groups being exempt from fasting according to religious text," he added.
Other findings reveal that blood glucose levels in the metformin and vildagliptin group after Ramadan were near recommended levels than the metformin and sulphonylurea group. The former group also reported no adverse events during the study, whereas 50 percent of the latter group had at least one adverse event.
Kuwait diabetes experts say the findings underscore the importance of doctors prescribing the correct medications for patients, especially at times when food intake is low or sporadic.
Dr Waleed Aldahi, Consultant Endocrinologist and Diabetologist at Mubarak Al-Kabir Hospital said the study's findings were significant for Muslim patients with type 2 diabetes, as even in cases where doctors advised against fasting, patients tended to fast regardless.
"This study investigates the incidence of hypoglycaemia in Muslim type 2 diabetic patients during Ramadan, indicating that not only did patients not experience hypoglycaemic events when taking vildagliptin in combination with metformin, but ultimately experienced better blood glucose control post-Ramadan," said Dr Al Dahi, who is also the Program Director of Kuwait Endocrine and Diabetes Fellowship Program, and who also spoke at the event.
Type 2 diabetes affects more than 21 percent of Kuwait's population aged 20 to 79 years(2) and is commonly caused by obesity; another major health problem in Kuwait where around 23 percent of males and females are classed as overweight or obese, according to World Health Organization data from 2000 and 2006 (3).
"When extrapolated to the global Muslim population with a similar clinical background, the study's findings could have considerable public health and clinical implications," said Dr. Thaier Al-Muaili, Internal Medicine Specialist and Diabetologist, and General Secretary of the Kuwait Diabetes Society.
"Ramadan is a good time for specific Muslim patients with diabetes to improve their conditions, and we encourage them to eat well at iftar, exercise and follow their prescribed treatments during the holy month," continued Dr Al-Muaili, who chaired the speaking event.
Symptoms of hypoglycaemia include nervousness, sweating, intense hunger, trembling, weakness, palpitations, and sufferers often have trouble speaking. In severe cases people require hospitalisation and it can even lead to coma and death. Research suggests that the overall mortality rate of severe hypoglycaemia - when induced by treatment with sulphonylurea alone - is around nine percent (4).
The cost implications of severe hypoglycaemia are also important for healthcare organisations to note, with each hospital admission for a severe event estimated to cost in the UK region of ~£1,000 (430 KWD) (5).
Vildagliptin is a DPP-4 inhibitor that works by blocking the breakdown of 'incretin' hormones in the body that stimulate the pancreas to produce insulin. Its mechanism of action targets the dysfunction in the pancreatic islet alpha and beta cells that cause high blood sugar levels in people with type 2 diabetes (6).
"The field of diabetes, with specific regard to Ramadan, has become very dynamic. There is a lot of active work on the role of structured medication regimens for Muslim patients in terms of improved safety and patient outcomes for those that are medically fit to fast - within the next two to three years we hope to have enough information to update guidelines for fasting patients," added Dr Hassanein.
References:
[1] Current Medical Research and Opinion: 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
July 2011, Vol. 27, No. 7, Pages 1367-1374 (doi:10.1185/03007995.2011.579951)
http://informahealthcare.com/doi/abs/10.1185/03007995.2011.579951
[2] International Diabetes Federation. IDF Diabetes Atlas, 5th edn. Brussels, Belgium: International Diabetes Federation, 2011
[3] World Health Organization, Global Infobase; https://apps.who.int/infobase/Indicators.aspx?ISO3=kwt
[4] Campbell IW. Horm Metab Res Suppl 1985;15:105-111
[5] Amiel SA, et al. Diab Med 2008;25:245-54
[6] European Public Assessment Report (EPAR) GALVUS EPAR summary for the public. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Summary_for_the_public/human/000771/WC500020328.pdf Last accessed 12 June 2012
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