Efficacy and Safety of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitor Use during Ramadan Fasting: A Systematic Review

Abstract

Background Religious intermittent fasting for 30 days during Ramadan may increase the risk of dehydration, hypovolemia, and hypoglycemia. These events may also be encountered when using sodium-glucose cotransporter 2 inhibitors (SGLT2is).

Objectives This article evaluates the safety of the SGLT2 inhibitors in people with type 2 diabetes during Ramadan.

Search Methods We searched PubMed CENTRAL, MEDLINE, and Google Scholar on July 25, 2023 without language restrictions.

Selection Criteria All trials assessing the safety of SGLT2 inhibitors during Ramadan were assessed and summarized into preset points.

Data Extraction Two authors independently extracted and reviewed the retrieved studies. A third author reviewed the merged summary of the two authors and modified the article when necessary.

Results Diabetic ketoacidosis, hospitalization due to diabetes-related problems, and thrombosis were either not significantly related to SGLT2i use or not studied. Estimated glomerular filtration rate (eGFR) dropped significantly in one study; otherwise, it was either not statistically significant or not studied. Hypovolemia and dehydration were significantly increased in one study only.

Conclusion From the available evidence, the use of SGLT2 inhibitors in people with diabetes during Ramadan seems to be safe and well tolerated. Hypovolemia and a drop in eGFR were reported in a few studies, with no reported clinical significance.

Keywords

fasting - Ramadan - Ramadan fasting - safety - SGLT2i

Authors' Contributions

All named authors contributed to the study's conception and conduct and to the manuscript's drafting and finalization. They have all reviewed and approved its final version.

Funding

None.

Compliance with Ethical Principles

Ethical approval is not required for a systematic review type of study.

Note

E.A., A.B., S.B., M.H. reported:

Presenting in medical platforms which may be compensated by an agreed upon honoraria.

A.B., F.Y., M.H., S.B. reported:

Payment or honoraria for lectures and support for major academic conferences.

Publication History

Article published online:
16 October 2024

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