The effect of Ramadan fasting and continuing sodium-glucose co-transporter-2 (SGLT2) inhibitor use on ketonemia, blood pressure and renal function in Muslim patients with type 2 diabetes.

OBJECTIVE: The effect of Ramadan fasting and continuing sodium-glucose co-transporter-2 (SGLT2) inhibitor use on ketonemia, blood pressure and renal function in Muslim patients with type 2 diabetes. METHODS: This is a single-centre prospective observational controlled cohort study. Muslim patients aged 21-75 years with type 2 diabetes and estimated glomerular filtration rate (eGFR) ≥ 45 ml/min/1.73 m2 were eligible if they had no contraindication to observe Ramadan fasting. Patients in study group were on stable dose of SGLT2 inhibitor for at least 3 months before enrolment and continued during study period, while patients in control group were not on SGLT2 inhibitor before and during study period. All participants attended baseline visit before Ramadan and follow-up visit during Ramadan. RESULTS: A total of 68 patients of similar baseline characteristics were included in the study: 35 in study group and 33 in control group. During Ramadan fasting, patients from study and control group had similar change in weight (LS mean change of -1.8 versus -1.1 kg, p = 0.205), eGFR (LS mean change of -6.0 versus -4.2 ml/min/1.73 m2, p = 0.399), sitting systolic BP (LS mean change of -8.1 versus -10.4 mmHg, p = 0.569), sitting diastolic BP (LS mean change of -3.7 versus -3.5 mmHg, p = 0.934) and plasma ß-hydroxybutyrate level (LS mean change of -0.01 versus -0.02 mmol/L, p = 0.649). CONCLUSIONS: Ramadan fasting was associated with significant changes in weight, BP and eGFR regardless whether patients were on SGLT2 inhibitor treatment. Continued use of SGLT2 Inhibitors during Ramadan did not increase ketonemia, nor increase risk of eGFR deterioration and hypoglycaemia.

Short-term outcomes of patients with Type 2 diabetes mellitus treated with canagliflozin compared with sitagliptin in a real-world setting.

INTRODUCTION: We aimed to evaluate the effectiveness and safety of canagliflozin as compared to sitagliptin in a real-world setting among multiethnic patients with Type 2 diabetes mellitus (T2DM) in Singapore. METHODS: This was a new-user, active-comparator, single-centre retrospective cohort study. Patients aged 18-69 years with T2DM and estimated glomerular filtration rate ≥ 60 mL/min/1.73 m2 were eligible for inclusion if they were initiated and maintained on a steady daily dose of canagliflozin 300 mg or sitagliptin 100 mg between 1 May and 31 December 2014, and followed up for 24 weeks. RESULTS: In total, 57 patients (canagliflozin 300 mg, n = 22; sitagliptin 100 mg, n = 35) were included. The baseline patient characteristics in the two groups were similar, with overall mean glycated haemoglobin (HbA1c) of 9.4% ± 1.4%. The use of canagliflozin 300 mg was associated with greater reductions in HbA1c (least squares [LS] mean change -1.6% vs. -0.4%; p < 0.001), body weight (LS mean change -3.0 kg vs. 0.2 kg; p < 0.001) and systolic blood pressure (LS mean change: -9.7 mmHg vs. 0.4 mmHg; p < 0.001), as compared with sitagliptin 100 mg. About half of the patients on canagliflozin 300 mg reported mild osmotic diuresis-related side effects that did not lead to drug discontinuation. CONCLUSION: Our findings suggest that canagliflozin was more effective than sitagliptin in reducing HbA1c, body weight and systolic blood pressure in patients with T2DM, although its use was associated with an increased incidence of mild osmotic diuresis-related side effects.