Association between SGLT2 inhibitors and diabetic ketoacidosis among patients fasting in Ramadan

Abstract

Abstract Aims: The use of SGLT2 inhibitors during Ramadan may be unsafe (risk of ketoacidosis, postural hypotension and dehydration), specifically during long hours of Ramadan fasting in hot climates. The objective of this study was to determine the main risk factors associated with the increased occurrence of DKA during Ramadan among patients utilising SGLT2 inhibitors and assess DKA risk during Ramadan. Methods: This retrospective diagnostic study assessed the role of SGLT2 inhibitors in 99 patients (50 men and 49 women) with declared diabetes mellitus treated with empagliflozin and followed-up in diabetes clinics. The main variables were: 1. Demographic data (age and gender). 2. Number of break days during Ramadan fasting. 3. Comorbidities associated with diabetes. 4. Signs and symptoms of DKA. Most of the patients (61 subjects) had a 6–10 year diabetes history, and 93 patients continued their regular follow-up. About 93% of the patients were used to Ramadan fasting, whereas only five patients did not fast in Ramadan. Results: Thirty-one of the fasting patients broke fasting during Ramadan for 1–5 days, and only two patients did so for more than 6 days. Patients exhibited known diabetes mellitus complications, such as hypertension, dyslipidaemia, cardiovascular and other associated diseases. None of the participants showed diabetic ketoacidosis signs and symptoms. Conclusions: SGLT2 inhibitors are considered an effective antidiabetic agent that can be safely used in patients with diabetes who are fasting in Ramadan.