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Open Access
CC BY 4.0 · Journal of Diabetes and Endocrine Practice
DOI: 10.1055/s-0045-1812031
Original Article

Characteristics of Fasting in Ramadan in Type 2 Diabetes Patients on Empagliflozin in the DAR Global Surveys of 2020 and 2022

Autoren

  • Mohamed Hassanein 

    1   Department of Diabetes and Endocrinology, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates

  • Khadija Hafidh 

    2   Department of Diabetes and Endocrinology, Rashid Hospital, Dubai Academic Health Corporation, Dubai, United Arab Emirates

  • Shehla Shaikh

    3   KGN Diabetes and Endocrinology Center, Mumbai, India

  • Inass Shaltout

    4   Department of Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt

  • Rachid Malek

    5   Department of Internal Medicine, CHU, Setif, Algeria

  • Zanariah Hussein

    6   Medical Endocrine Unit, Internal Medicine Department, Endocrine Institute, Putrajaya Hospital, Putrajaya, Malaysia

  • Reem Alamoudi 

    7   Department of Medicine, King Abdulaziz Medical City and King Abdullah International Research Centre, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia

  • Muhammad Yakoob Ahmedani

    8   Department of Diabetes, Tabba Heart Institute, Karachi, Pakistan

Funding and Sponsorship Funding to support medical writing was provided through an unrestricted educational grant by Boehringer Ingelheim (BI). However, BI had no role in the design, analysis or interpretation of the results in this study. BI was given the opportunity to review the manuscript for medical and scientific accuracy as it relates to BI substances, as well as intellectual property considerations.
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Abstract

Background

The safety of Ramadan fasting in individuals is determined by an interplay between Ramadan, patients, and medication factors.

Objective

To analyze the challenges associated with Ramadan fasting among patients with diabetes treated with Empagliflozin and other antiglycemic agents who participated in the Diabetes and Ramadan (DAR) global surveys of 2020 and 2022.

Methods

Building on data from the DAR Global surveys, a sub-analysis was performed on patients treated with Empagliflozin (n = 1,464) to reflect on the patients' experience and to analyze the challenges associated with Ramadan fasting.

The observational survey was conducted in five geographic regions (Gulf countries, Maghreb countries, Middle East [Egypt, Türkiye, and Iraq], Indian subcontinent, and Southeast Asia) in Muslim type 2 diabetes patients post-Ramadan 2020 and 2022. The patients were divided into four groups: Those treated with (1) Empagliflozin without sulphonylureas or insulins, (2) Empagliflozin plus sulphonylureas, (3) Empagliflozin plus insulins, and (4) Empagliflozin plus sulphonylureas and insulins. Descriptive statistics on medical data and baseline demographics were generated, and odds ratios regarding symptomatic hyper- and hypoglycemic events were calculated. The fasting behavior as well as diabetes management of the patients were evaluated.

Results

Despite having diabetes, a large proportion of patients fasted during Ramadan. Patients treated with Empagliflozin without sulphonylureas or insulins showed significantly lower symptomatic hypo- and hyperglycemic complication rates during Ramadan fasting (6.9 and 8.4%, respectively). In patients on concomitant treatment with sulphonylureas, slightly higher rates of symptomatic hyper- and hypoglycemic events were observed. In patients who received insulins, significantly higher rates of symptomatic hyper- and hypoglycemic events were observed. The highest rates of symptomatic hypo- and hyperglycemic events (19.7 and 22.2%, respectively) were observed in patients who were given concomitant treatment with sulphonylureas and insulins, with odds ratios up to 3.31 compared to Empagliflozin without sulphonylureas or insulins. Very low hospitalization rates (0.38%) due to symptomatic hyper- and hypoglycemic events were observed.

Conclusion

Hypoglycemia rates were influenced by the type of therapies administered to the patients. Based on the results of this study, it may be concluded that Empagliflozin monotherapy or in combination with sulphonylureas may be relatively safe for Ramadan fasting, whereas caution is advised for patients taking additional insulin combinations.

Keywords

Ramadan - fasting - type 2 diabetes - Empagliflozin - hypoglycemia - hyperglycemia

Author Confirmation

All the authors contributed to the conduct of the study and preparation of the manuscript. It is hereby confirmed that the manuscript has been read and approved by all named authors and that no other persons have satisfied the criteria for authorship.


Compliance with Ethical Principles

The surveys, which were the basis for the present sub-analysis, had the approval of the local research and ethics authorities in each participating country, according to local regulations.


Data Availability Statement

The original data supporting this study can be obtained by reasonable request to the corresponding author.




Publikationsverlauf

Artikel online veröffentlicht:
03. November 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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