Continuous glucose monitoring in glimipiride plus metformin treated type 2 diabetic patients during Ramadan month

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Ibtissem Oueslati
Rania Ben Said
Ines Kammoun
Emna Haouat
Leila Ben Salem
Zinet Turki
Claude Ben Slama

Abstract

Background : Fasting during Ramadan may be a cause of poor glycaemic control in diabetic patients.
Aim: To assess glucose excursions during Ramadan by using a continuous glucose monitoring system (CGMS).
Methods: The interstitial glucose level was recorded over 72 hours during Ramadan and three months later, in five type 2 diabetic patients, aged 56 ± 5, treated with glimepiride and metformin.
Results: During Ramadan, four patients experienced at least one episode of low glucose level (<0.7 g/l) during the monitoring. The frequency of these episodes was 0.6 episode/d with an average duration of 36 mn / d. These episodes occurred in the morning in half of the cases and in the hour before breaking the fast in 37.5 % of the cases. Four patients experienced at least one episode of high glucose level (>1.8 g/l), with an average duration of 403 mn /d and with a frequency of two episodes /d. More than half episodes (53) occurred after the breaking of the fast. After Ramadan, CGM records showed at least one episode of low glucose in two patients with an average duration of 58 mn /d and a frequency of 1.3 episodes/d. Three patients experienced at least one episode of high glucose level with an average duration of 525 mn /d and a frequency of 1.46 episodes/day.
Conclusion: The blood glucose profile of our patients during Ramadan is characterized by important glycaemic excursions.

Keywords:

Type 2 diabetes; glimepiride; continuous glucose monitoring; Ramadan fasting.

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References

  1. Salti I, Benard E, Detournay B et al. A population based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diabetes Care 2004; 27: 2306-11.
  2. Beshyah SA, Jowett NI, Burden AC. Effect of Ramadan fasting on metabolic control in diabetes. Diabet Med 1988; 5: 32-3.
  3. Al-Arouj M, Assaad-Khalil S, Buse J et al. Recommendations for management of diabetes during Ramadan: update 2010. Diabetes Care. 2010; 33:1895-902.
  4. Bravis V, Hui E, Salih S, Mehar S, Hassanein M, Devendra D. Ramadan Education and Awareness in Diabetes (READ) program for Muslims with type 2 diabetes who fast during Ramadan. Diabet Med 2010; 27:327-31.
  5. Aravind SR, Al Tayeb K, Ismail SB et al. Hypoglycaemia in sulphonylurea-treated subjects with type 2 diabetes undergoing Ramadan fasting: a five-country observational study. Curr Med Res Opin 2011; 27:1237-42.
  6. Zargar A, Basit A, Mahtab H. Sulphonylureas in the management of type 2 diabetes during the fasting month of Ramadan. J Indian Med Association 2005; 103: 444-6.
  7. Al Sifri S, Basiounny A, Echtay A et al. The incidence of hypoglycaemia in Muslim patients with type 2 diabetes treated with sitagliptin or a sulphonylurea during Ramadan: a randomised trial. Int J Clin Pract 2011; 65: 1132-40.
  8. Ahmedani MY, Ul Haque MS, Basit A, Fawwad AAlvi SF. Ramadan Prospective Diabetes Study: the role of drug dosage and timing alteration, active glucose monitoring and patient education. Diabet Med. 2012; 29:709-15.
  9. Garg S, Zisser H, Schwartz S et al. Improvement in glycemic excursions with a transcutaneous, real-time, continuous glucose sensor: a randomized controlled trial. Diabetes Care 2006; 29: 44- 50.
  10. Wojciechowski P, Rys P, Lipowska A, Gaweska M, Malecki MT.. Efficacy and safety comparison of continuous glucose monitoring and self-monitoring of blood glucose in type 1 diabetes: systematic review and meta-analysis. Pol Arch Med Wewn 2011; 121: 333-43.
  11. Glimepiride in Ramadan (GLIRA) Study Group. The efficacy and safety of glimepiride in the management of type 2 diabetes in muslim patients during Ramadan. Diabetes Care 2005; 28: 421-2.