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Acta Diabetol (2009) 46:6365 DOI 10.1007/s00592-008-0062-7
ORIGINAL ARTICLE
Repaglinide plus single-dose insulin glargine: a safe regimen for low-risk type 2 diabetic patients who insist on fastingin Ramadan
Okan Bakiner Melek E. Ertorer Emre Bozkirli Neslihan B. Tutuncu Nilgun G. Demirag
Received: 7 December 2007 / Accepted: 11 September 2008 / Published online: 30 September 2008 Springer-Verlag 2008
Abstract Aim of this prospective study is to evaluate the effect of repaglinide t.i.d. (three times a day) plus single-dose insulin glargine regimen in low-risk type 2 diabetic patients during Ramadan fasting. Participants had been taking the regimen for at least 3 months. Patients with a history of diabetic coma, severe hypoglycemic crisis or repeating attacks of hypoglycemia were excluded. Hypoglycemic unawareness, kidney or liver disease or HbA1c over 8% were also accepted as exclusion criteria. Eleven patients who insisted on this worship and eight non-fasting cases were involved. All were told to make home-glucosemonitorisation weekly and report any hypoglycemic event throughout Ramadan. Fasting blood glucose (FBG), post-prandial blood glucose (PBG) and fructosamine levels, body weights and blood pressures were recorded just before and after Ramadan. Seven patients in each group concluded the follow-up. Any signicant change was detected in the parameters in either groups (P [ 0.05). Glucose control remained unchanged; fructosamine 318.14 65.38 versus 317.28 52.80 mmol/L in fasting group, 290.71 38.48 versus 290 38.56 mmol/L in non-fasting group. None of them exhibited either a major or a minor hypoglycemic event. The results of this pilot study indicated that repaglinide t.i.d. plus single-dose
insulin glargine regimen was safe for low-risk type 2 diabetic patients who insisted on fasting during Ramadan.
Keywords Fasting hypoglycemia
Hypoglycemic agents Insulin analogs
Introduction
Fasting during Ramadan, the holy month of Islam, is an obligatory duty for healthy adult Muslims. People who fast during Ramadan must abstain from eating, drinking, smoking and taking medications from daybreak to sunset. The EPIDIAR study showed that about 4050 millions of diabetic patients insisted on fasting during Ramadan, despite of the warnings of their doctors and religious authorities [1, 2]. Insulin glargine is a long-acting insulin analog which mimicks basal insulin secretion without exhibiting serum peaks [3]. Repaglinide is an oral short-acting insulin secretagogue which helps to regulate post-prandial glucose elevation [4]. Repaglinide t.i.d. with single-dose...