RESUMO
Background: Type 2 Diabetes Mellitus (T2DM) patients are exposed to a 7.5 times higher risk of hypoglycemia while fasting during Ramadan. Relevant diabetes guidelines prioritize the use of SGLT2 inhibitors over other classes. There is a great need to enrich data on their safe and effective use by fasting patients at greater risk of hypoglycemia. Therefore, this study aims to assess the safety and tolerability of Empagliflozin in T2DM Muslim patients during Ramadan. Methodology: A prospective cohort study was conducted for adult Muslim T2DM patients. Patients who met the inclusion criteria were categorized into two sub-cohorts based on Empagliflozin use during Ramadan (Control versus Empagliflozin). The primary outcomes were the incidence of hypoglycemia symptoms and confirmed hypoglycemia. Other outcomes were secondary. All patients were followed up to eight weeks post-Ramadan. A propensity score (PS) matching and Risk Ratio (RR) were used to report the outcomes. Results: Among 1104 patients with T2DM who were screened, 220 patients were included, and Empagliflozin was given to 89 patients as an add-on to OHDs. After matching with PS (1:1 ratio), the two groups were comparable. The use of other OHDs, such as sulfonylurea, DPP4 inhibitors, and Biguanides, was not statistically different between the two groups. The risk of hypoglycemia symptoms during Ramadan was lower in patients who received Empagliflozin than in the control group (RR 0.48 CI 0.26, 0.89; p-value = 0.02). Additionally, the risk of confirmed hypoglycemia was not statistically significant between the two groups (RR 1.09 CI 0.37, 3.22; p-value = 0.89). Conclusion: Empagliflozin use during Ramadan fasting was associated with a lower risk of hypoglycemia symptoms and higher tolerability. Further randomized control trials are required to confirm these findings.
RESUMO
BACKGROUND AND OBJECTIVES: Describe the epidemiology and characteristics of Middle East respiratory syndrome coronavirus (MERS-CoV), which are essential for control and treatment. METHODS: We conducted a retrospective review of all cases of MERS-CoV reported in four cities of the Makkah Region from March to June 2014. Exposure factors and comorbid conditions were analyzed using Epi Info. RESULTS: Analysis of the 261 cases revealed that the incidence peaked in mid-April 2014 and the fatality rate was 42%. Cough, fever, radiological evidence of pneumonia, and shortness of breath were identified as significant risk factors for a diagnosis of MER-CoV infection. Healthcare workers (HCWs) are at a higher risk of acquiring MERS-CoV than non-HCWs. Males in Jeddah are at higher risk due to greater outdoor exposure while females in Taif are at higher risk due to domestic caregiving. Filipino nurses are at highest risk among all HCWs. CONCLUSION: The findings indicate the need to screen all contacts of HCWs to improve MERS control and form public-private partnerships to investigate the true burden of MERS.
