Huai Heng Loh1, Anne Yee2, Huai Seng Loh3, Norlela Sukor4, Nor Azmi Kamaruddin4. 1. Faculty of Medicine and Health Sciences, University of Malaysia Sarawak, Jalan Datuk Mohd Musa, 94300 Kota Samarahan, Sarawak, Malaysia. Electronic address: hh_loh@yahoo.com.my. 2. Department of Psychological Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. 3. Clinical Academic Unit, Newcastle University Medicine Malaysia, No. 1, Jalan Sarjana 1, Kota Ilmu, Educity@Iskandar, 79200 Nusajaya, Johor, Malaysia. 4. Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, Malaysia.
Abstract
AIM: To systematically review the literature to compare the use of DPP4 inhibitors vs sulphonylurea in type 2 diabetic Muslim patients who fast in Ramadan, with regards to its safety, tolerability, glycemic control, and body weight changes. METHODS: All English-language medical literature published from inception till October 2014 which met the inclusion criteria were reviewed and analyzed. RESULTS: A total of nine papers were included, reviewed and analyzed. The total sample size was 4276 patients. All studies used either of the two DPP4 inhibitors - Vildagliptin or Sitagliptin, vs sulphonylurea or meglitinides. Patients receiving DPP4 inhibitors were less likely to develop symptomatic hypoglycemia (risk ratio 0.46; 95% CI, 0.30-0.70), confirmed hypoglycemia (risk ratio 0.36; 95% CI, 0.21-0.64) and severe hypoglycemia (risk ratio 0.22; 95% CI, 0.10-0.53) compared with patients on sulphonylureas. There was no statistically significant difference in HbA1C changes comparing Vildagliptin and sulphonylurea. CONCLUSION: DPP4 inhibitor is a safer alternative to sulphonylurea in Muslim patients with type 2 diabetes mellitus who fast during the month of Ramadan as it is associated with lower risk of symptomatic, confirmed and severe hypoglycemia, with efficacy comparable to sulphonylurea.
AIM: To systematically review the literature to compare the use of DPP4 inhibitors vs sulphonylurea in type 2 diabetic Muslim patients who fast in Ramadan, with regards to its safety, tolerability, glycemic control, and body weight changes. METHODS: All English-language medical literature published from inception till October 2014 which met the inclusion criteria were reviewed and analyzed. RESULTS: A total of nine papers were included, reviewed and analyzed. The total sample size was 4276 patients. All studies used either of the two DPP4 inhibitors - Vildagliptin or Sitagliptin, vs sulphonylurea or meglitinides. Patients receiving DPP4 inhibitors were less likely to develop symptomatic hypoglycemia (risk ratio 0.46; 95% CI, 0.30-0.70), confirmed hypoglycemia (risk ratio 0.36; 95% CI, 0.21-0.64) and severe hypoglycemia (risk ratio 0.22; 95% CI, 0.10-0.53) compared with patients on sulphonylureas. There was no statistically significant difference in HbA1C changes comparing Vildagliptin and sulphonylurea. CONCLUSION:DPP4 inhibitor is a safer alternative to sulphonylurea in Muslim patients with type 2 diabetes mellitus who fast during the month of Ramadan as it is associated with lower risk of symptomatic, confirmed and severe hypoglycemia, with efficacy comparable to sulphonylurea.
Authors: Kadriye Aydinkoc-Tuzcu; Karin Schindler; Alexandra Kautzky-Willer; Bernhard Ludvik; Peter Fasching Journal: Wien Klin Wochenschr Date: 2016-04 Impact factor: 1.704