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.