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CC BY 4.0 · Journal of Diabetes and Endocrine Practice 2026; 09(01): 137-145
DOI: 10.1055/s-0045-1814436
Original Article

Outcomes of People with Type 2 Diabetes using Sulfonylureas versus Other Non-Insulin Antidiabetic Agents during Ramadan: The Diabetes and Ramadan (DaR) Global Surveys

Authors

  • Mohamed Hassanein 

    1   Department of Medicine, Mohamed Bin Rashid University, Dubai, United Arab Emirates
    2   Department of Diabetes and Endocrinology, Dubai Hospital, Dubai, United Arab Emirates

  • M. Yakoob Ahmedani

    3   Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan

  • Shehla Shaikh

    4   KGN Diabetes and Endocrinology Center, Mumbai, Maharashtra, India

  • Inass Shaltout

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

  • Bachar Afandi

    6   Department of Endocrinology, Tawam Hospital, Al Ain, United Arab Emirates
    7   Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates

  • Lobna F. El Toony

    8   Department of Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt

  • Rashed Malek

    9   Department of Internal Medicine, Diabetes Clinic, Centre Hospitalier Universitaire Sétif, Setif, Algeria

  • Zanariah Hussein

    10   Endocrine Division, Department of Internal Medicine, Hospital Putrajaya, Putrajaya, Malaysia

  • Reem Alamoudi 

    11   Department of Endocrinology, King Abdulaziz Medical City, Saud Bin Abdulaziz University, Jeddah, Saudi Arabia

Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Abstract

Background

There is an increasing need to investigate fasting outcomes for Muslims with type 2 diabetes (T2D) who choose to fast during Ramadan. Although sulfonylureas (SUs) are widely used in T2D, concerns persist regarding their risk of hypoglycemia during prolonged fasting. Modern second-generation agents, particularly Gliclazide modified release (MR), have demonstrated improved pharmacokinetic stability and a lower risk of hypoglycemia compared with older sulfonylureas, such as glibenclamide. This study seeks to understand the reported fasting outcomes of patients using second-generation sulfonylureas during Ramadan.

Patients and Methods

The Diabetes and Ramadan (DaR) global survey was conducted in 14 countries and investigated patients with T2D who fasted during Ramadan in 2020 and 2022. The survey was administered by health care practitioners after Ramadan and compared those who used second-generation sulfonylureas with those deemed to be in the low-risk group (LRG).

Results

After excluding individuals with cardiovascular, renal, or foot complications, as well as those treated with insulin, 5,294 individuals were included in the analysis (mean age ≈53 years). Participants on sulfonylureas and those in the LRG showed similar fasting adherence, with over 90% completing the Ramadan fast. Among sulfonylurea users, Gliclazide MR had the highest proportion of fasting for the full month (77%) and the lowest reported incidence of hypoglycemia (10.3%), comparable to the LRG (7.9%, p = 0.2).

Conclusions

Fasting outcomes among participants using second-generation sulfonylureas were comparable to those on lower-risk oral agents during the Ramadan fasting period. Gliclazide MR demonstrated the most favorable profile, with the highest fasting blood glucose control rate and the lowest frequency of hypoglycemia among the sulfonylurea group. These findings support the safe use of modern sulfonylureas during Ramadan, provided it is under appropriate medical supervision. Further prospective and randomized studies are warranted to confirm the comparative safety and optimize treatment selection for individuals with T2D who fast.

Keywords

type 2 diabetes - Ramadan - fasting - Gliclazide MR - sulfonylureas - hypoglycemia - SMBG

Authors' Contributions

All the named authors contributed toward conception, data collection, writing, and final approval of the manuscript.


Ethical Approval

Ethical approval for the DaR Survey was granted by the Dubai Health Authority.




Publication History

Article published online:
18 December 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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