Evidence mapPaperPMID 35242880Full record

SynthesisJournal of diabetes research2022

Safety Assessment of Glucose-Lowering Drugs and Importance of Structured Education during Ramadan: A Systematic Review and Meta-Analysis.

Rashmi Shiju, Ayesha Akhil, Smitha Thankachan, Jaakko Tuomilehto, Monira Al Arouj, Abdullah Bennakhi

Open access · goldAbstract readMeta-AnalysisSystematic Review
In one paragraph

Synthesis in Journal of diabetes research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed
3.1field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 27 citations in OpenAlex.

  1. Trial
  2. Article
  3. Article
  4. Protective Effects of Isolated Curcumin FromJournal of diabetes research · 2025
    Article
  5. Article
  6. As a phenomenon: Ramadan fasting improves olfactory performance.Laryngoscope investigative otolaryngology · 2024
    Article
  7. Observational
  8. Article
  9. Review
  10. Review
  11. [Diabetes and migration (update 2023)].Wiener klinische Wochenschrift · 2023
    Article
  12. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 3 countries.

Rashmi ShijuOffice of Regulatory Affairs, Dasman Diabetes Institute, Kuwait.ORCID https://orcid.org/0000-0002-3794-6989
Ayesha AkhilOffice of Regulatory Affairs, Dasman Diabetes Institute, Kuwait.ORCID https://orcid.org/0000-0002-6304-345X
Smitha ThankachanOffice of Regulatory Affairs, Dasman Diabetes Institute, Kuwait.ORCID https://orcid.org/0000-0002-9530-5231
Jaakko TuomilehtoDepartment of Public Health, University of Helsinki, Helsinki, Finland.ORCID https://orcid.org/0000-0002-3424-0745
Monira Al AroujClinical Trials Unit, Dasman Diabetes Institute, Kuwait.ORCID https://orcid.org/0000-0002-8225-3284
Abdullah BennakhiOffice of Regulatory Affairs, Dasman Diabetes Institute, Kuwait.ORCID https://orcid.org/0000-0002-8899-8690
Dasman Diabetes Institute · KWUniversity of Helsinki · FI

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRamadan is the sacred month of the Islamic Hijri (lunar) calendar, and during this entire month, healthy adult Muslims abstain from eating and drinking from dawn to sunset. Muslims with Type 2 Diabetes Mellitus (T2DM) who choose to fast during Ramadan encounter major risks such as hypoglycemia, hyperglycemia, diabetic ketoacidosis, dehydration, and thrombosis. Although patients with poor glycemic control and on multiple insulin injections are at high risk and exempt from fasting, many still insist on it. Thus, healthcare professionals play a pivotal role in managing diabetes-related complications in patients who fast during Ramadan. However, there is a lack of standard guidelines to be followed in association with structured education and administration of drugs and dosage. Therefore, we performed a systematic review and meta-analysis of the literature to determine the safety and efficacy of different classes of drugs and the importance of structured education during Ramadan.

methodsIn this review, an extensive PubMed search was performed to obtain literature on T2DM patients who fast during the month of Ramadan until the year 2020. Preference was given to fully downloadable articles. The articles were extracted based on the eligibility criteria. The extracted data were analyzed using Review Manager software version 5.3.

resultsA total of 32 articles were included for the review and 7 studies for meta-analysis. Majority of the studies demonstrated the importance of structured education either as a group session or as a one-on-one session with the healthcare professionals in preventing diabetes-related risks during Ramadan. As far as glucose-lowering drugs are concerned, DPP-4 inhibitor combined with metformin remains the drug of choice for T2DM patients who fast during Ramadan. The newer class of glucose-lowering agents appear to lower the risk of hypoglycemia in comparison with sulphonylureas, while among sulphonylureas gliclazide is relatively safe. The meta-analysis indicates that DPP-4 inhibitors would significantly reduce the risk of hypoglycemia as compared to sulphonylurea (odds ratio = 0.38, 95% CI: 0.26 to 0.55,

conclusionThe results of our systematic review show that structured education and counselling by healthcare professionals can be an effective tool in preventing complications associated with fasting during Ramadan in people with T2DM. Additionally, the safest class of oral glucose-lowering drugs preferred during Ramadan fasting in T2DM patients is DPP-4 inhibitors.

Indexed as

AdultDiabetes Mellitus, Type 2HolidaysHumansHypoglycemic AgentsIslamMedication AdherencePatient Education as TopicHypoglycemic Agents

Identifiers

PMID35242880
PMCPMC8886741
OpenAlexW4213333898

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.