1887
Volume 2024, Issue 3
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Background: SGLT2 inhibitors are known for their osmotic diuretic effect, and their use by Muslim patients with type 2 diabetes during the fasting month of Ramadan may pose an increased risk of volume depletion, potentially impacting renal function.

Methods: We conducted a systematic review registered on PROSPERO (registration number CRD42020204582) of studies published between 2013 and January 2023, sourced from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. The study selection criteria included controlled studies that reported the use of SGLT2 inhibitors (SGLT2i) by fasting adult type 2 diabetes patients and provided data on creatinine or estimated glomerular filtration rate (eGFR) as outcomes.

Results: Two prospective observational studies, encompassing a total of 359 participants, of which 197 utilized SGLT2 inhibitors, were identified. Our findings indicated that the use of SGLT2 inhibitors during Ramadan did not result in a significant alteration in eGFR. In one study by Hassanein et al., the mean changes in eGFR for the SGLT2i group, as compared to the non-SGLT2i group, were -1.2 ± 19.4 and 3.1 ± 14.8, respectively ( = 0.06). In a study by Shao et al., the least squares mean changes for eGFR in the SGLT2i group, compared to the non-SGLT2i group, were -6.0 ± 1.5 (95% CI, -8.9 to -3.1) and -4.2 ± 1.6 (95% CI, -7.3 to -1.1), respectively ( = 0.39).

Conclusion: Despite the limited number of observational studies available, our analysis suggests that the use of SGLT2 inhibitors by type 2 diabetes patients during Ramadan does not appear to significantly impact kidney function.

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2024-08-06
2024-09-06
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References

  1. Kalra S. Sodium glucose co-transporter-2 (SGLT2) inhibitors: A review of their basic and clinical pharmacology. Diabetes Ther. 2014Dec; 5:(2):355-66.
    [Google Scholar]
  2. Rabizadeh S, Nakhjavani M, Esteghamati A. Cardiovascular and renal benefits of SGLT2 inhibitors: A narrative review. Int J Endocrinol Metab [Internet]2019Apr; 17:(2):e84353. doi: 10.5812/ijem.84353
    [Google Scholar]
  3. Perlman A, Heyman SN, Matok I, Stokar J, Muszkat M, Szalat A. Acute renal failure with sodium-glucose-cotransporter-2 inhibitors: Analysis of the FDA adverse event report system database. Nutr Metab Cardiovasc Dis. 2017Dec; 27:(12):1108-13.
    [Google Scholar]
  4. U.S. Food Drug & Administration. FDA Drug Safety Communication: FDA strengthens kidney warnings for diabetes medicines canagliflozin (Invokana, Invokamet) and dapagliflozin (Farxiga, Xigduo XR). FDA [Internet]. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-strengthens-kidney-warnings-diabetes-medicines-canagliflozin. Accessed: April 3, 2021.
    [Google Scholar]
  5. Nadkarni GN, Ferrandino R, Chang A, Surapaneni A, Chauhan K, Poojary P, et al.. Acute kidney injury in patients on SGLT2 inhibitors: A propensity-matched analysis. Diabetes Care. 2017Nov; 40:(11):1479-85.
    [Google Scholar]
  6. Sridhar VS, Tuttle KR, Cherney DZI. We can finally stop worrying about SGLT2 inhibitors and acute kidney injury. Am J Kidney Dis. 2020Oct 1; 76:(4):454-6.
    [Google Scholar]
  7. Menne J, Dumann E, Haller H, Schmidt BMW. Acute kidney injury and adverse renal events in patients receiving SGLT2-inhibitors: A systematic review and meta-analysis. PLoS Med. 2019Dec 9; 16:(12):e1002983.
    [Google Scholar]
  8. Diabetes Care: 44 (Supplement 1). Diabetes Care [Internet]. https://care.diabetesjournals.org/content/44/Supplement_1. Accessed: January 1, 2021.
    [Google Scholar]
  9. Tuttle KR, Brosius FC, Cavender MA, Fioretto P, Fowler KJ, Heerspink HJL, et al.. SGLT2 inhibition for CKD and cardiovascular disease in type 2 diabetes: Report of a scientific workshop sponsored by the National Kidney Foundation. Am J Kidney Dis. 2021Jan1; 77:(1):94-109.
    [Google Scholar]
  10. WHO EMRO Dietary recommendations for the month of Ramadan | Nutrition-infocus Nutrition [Internet]. http://www.emro.who.int/nutrition/nutrition-infocus/dietary-recommendations-for-the-month-of-ramadan.html. Accessed: August 13, 2020.
    [Google Scholar]
  11. [Google Scholar]
  12. Leiper JB, Molla AM, Molla AM. Effects on health of fluid restriction during fasting in Ramadan. Eur J Clin Nutr. 2003Dec; 57:(2):S30-8.
    [Google Scholar]
  13. Beshyah SA, Chatterjee S, Davies MJ. Use of SGLT2 inhibitors during Ramadan: A survey of physicians’ views and practical guidance. Br J Diabetes. 2016Mar8; 16:(1):20-4.
    [Google Scholar]
  14. Hassanein M, Echtay A, Hassoun A, Alarouj M, Afandi B, Poladian R, et al.. Tolerability of canagliflozin in patients with type 2 diabetes mellitus fasting during Ramadan: Results of the Canagliflozin in Ramadan Tolerance Observational Study (CRATOS). Int J Clin Pract [Internet]. 2017Oct; 71:(10):e12991. doi: 10.1111/ijcp.12991
    [Google Scholar]
  15. Shao Y, Lim GJ, Chua CL, Wong YF, Yeoh ECK, Low SKM, et al.. The effect of Ramadan fasting and continuing sodium-glucose co-transporter-2 (SGLT2) inhibitor use on ketonemia, blood pressure and renal function in Muslim patients with type 2 diabetes. Diabetes Res Clin Pract. 2018Aug1; 142:85-91.
    [Google Scholar]
  16. Wan Seman WJ, Kori N, Rajoo S, Othman H, Mohd Noor N, Wahab NA, et al.. Switching from sulphonylurea to a sodium-glucose cotransporter2 inhibitor in the fasting month of Ramadan is associated with a reduction in hypoglycaemia. Diabetes Obes Metab. 2016; 18:(6):628-32.
    [Google Scholar]
  17. Rashid F, Abdelgadir E. A systematic review on efficacy and safety of the current hypoglycemic agents in patients with diabetes during Ramadan fasting. Diabetes Metab Syndr Clin Res Rev. 2019Mar1; 13:(2):1413-29.
    [Google Scholar]
  18. Diabetes and Ramadan [Internet]. https://idf.org/our-activities/education/diabetes-and-ramadan.html. Accessed: April 3, 2021.
    [Google Scholar]
  19. Abdelgadir E, Rashid F, Bashier A, Al Saeed M, Khalifa A, Alawadi F, et al.. Use of flash glucose monitoring system in assessing safety of the SGLT2 inhibitors during Ramadan fasting in high risk insulin treated patients with type 2 diabetes. Diabetes Metab Syndr Clin Res Rev. 2019; 13:(5):2927-32.
    [Google Scholar]
  20. Bashier A, Khalifa AA, Abdelgadir EI, Al Saeed MA, Al Qaysi AA, Ali Bayati MB, et al.. Safety of sodium-glucose cotransporter 2 inhibitors (SGLT2-I) during the month of Ramadan in muslim patients with type 2 diabetes. Oman Med J. 2018; 33:(2):104-10.
    [Google Scholar]
  21. Ottawa Hospital Research Institute [Internet]. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed: April 3, 2021.
    [Google Scholar]
  22. Yanli YS, Lim GJ, Chua CL, Wong YF, Yeoh E, Serena Low KM, et al.. The safety of continuing sodium-glucose cotransporter 2 (SGLT2) inhibitor during ramadan fasting in muslim patients with type 2 diabetes. Diabetes. 2018; 67:A322.
    [Google Scholar]
  23. Efficacy and safety of SGLT2 in Ramadan - Virtual Meeting EASD [Internet]. https://www.easd.org/virtualmeeting/home.html#!resources/efficacy-and-safety-of-sglt2-in-ramadan. Accessed: April 3, 2021.
    [Google Scholar]
  24. Majewski C, Bakris GL. Blood pressure reduction: An added benefit of sodium-glucose cotransporter 2 inhibitors in patients with Type 2 diabetes. Diabetes Care. 2015Mar1; 38:(3):429-30.
    [Google Scholar]
  25. Ansary TM, Nakano D, Nishiyama A. Diuretic effects of sodium glucose cotransporter 2 inhibitors and their influence on the renin-angiotensin system. Int J Mol Sci [Internet]. 2019Feb1; 20:(3):629. doi: 10.3390/ijms20030629
    [Google Scholar]
  26. Seidu S, Kunutsor SK, Cos X, Gillani S, Khunti K. SGLT2 inhibitors and renal outcomes in type 2 diabetes with or without renal impairment: A systematic review and meta-analysis. Prim Care Diabetes. 2018Jun; 12:(3):265-83.
    [Google Scholar]
  27. Neuen BL, Young T, Heerspink HJL, Neal B, Perkovic V, Billot L, et al.. SGLT2 inhibitors for the prevention of kidney failure in patients with type 2 diabetes: A systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2019Nov; 7:(11):845-54.
    [Google Scholar]
  28. Abushady MM, Samy M, Bekhet M, Abdullah A. Effect of Ramadan fasting on renal function in patients with type 2 diabetes. Diabetes Res Clin Pract. 2019Jul; 153:176-83.
    [Google Scholar]
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  • Article Type: Research Article
Keyword(s): fastingkidney functionRamadanSGLT2 inhibitors and systematic review
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