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Prescription Diabetes Drugs
Posted by admin in Prescription Diabetes Drugs on October 02nd, 2009
The addition of the dipeptidyl peptidase 4 (DPP-4) inhibitor vildagliptin to metformin therapy in fasting Muslim patients with Type 2 diabetes reduces the incidence of hypoglycemia compared with the addition of the sulfonylurea gliclazide, research suggests.
“If a person with diabetes chooses to fast during Ramadan, his or her decision needs to be respected and an appropriate care plan needs to be devised,” explain the study authors Devasenan Devendra (Central Middlesex Hospital, London, UK) and co-workers.
To study the impact of Ramadan fasting by Muslims with Type 2 diabetes in the UK, the authors followed 52 patients attending primary care practices in north-west London for an average of 7.5 weeks.
Participants had glycated hemoglobin (HbA1c) greater than 8.5% despite treatment with metformin 2 g daily before Ramadan, and were receiving gliclazide 160 mg twice daily or vildagliptin 50 mg twice daily in addition to metformin.
Hypoglycemic events (defined as blood glucose of less than 3.5 mmol/l with or without symptoms), HbA1c, and weight were recorded 2 weeks before and 10 days after the Ramadan fast.
Patients receiving gliclazide experienced a total of 24 hypoglycemic events, one of which was severe, while those receiving vildagliptin experience a total of two hypoglycemic events, neither of which were severe. Among patients receiving the sulfonylurea, 62% suffered a hypoglycemic event, compared with 8% of those taking vildagliptin.
“Vildagliptin was associated with a reduction in the mean number of hypoglycemic events during Ramadan compared with before Ramadan (when patients were on metformin monotherapy), whereas gliclazide was associated with an increase,” write the authors.
Gliclazide and vildagliptin were associated with similar reductions in HbA1c of 1.23% and 1.26%, respectively. Both agents were associated with a small non-significant increase in weight of 0.38 kg and 0.12 kg, respectively.
The authors acknowledge that this was an observational study of a relatively small number of patients with Type 2 diabetes and highlight the need for larger, prospective studies of the different interventions that may help Muslim patients fast safely during Ramadan.
“Newer antidiabetic agents, such as vildagliptin, may have a role to play in the management of these patients during Ramadan, particularly to reduce their risk of hypoglycemia during the long daytime fasting periods,” they conclude in the International Journal of Clinical Practice.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
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