Sodium-glucose cotransporter-2 inhibitors (SGLT2-i) improve glycemic control and weight, but may be associated with dehydration, hypotension and ketoacidosis, especially in patients with type-2 diabetes mellitus (T2DM) who fast during Ramadan. This meta-analysis evaluates the effects of Ramadan fasting on T2DM patients treated with SGLT-2i.

A literature search was done in PubMed, Embase, and the Cochrane Library. Quality assessment was done using the ROBINS-I and Cochrane tools for risk of bias and analyses were performed using RevMan version 5.3.

A total of 5 studies were included in this meta-analysis. During Ramadan there was a significant reduction in HbA1c (P<0.00001) and diastolic blood pressure (P=0.006) with a non-significant trend for a reduction in weight (P=0.44) and systolic blood pressure (P=0.67). The number and severity of hypoglycemic episodes was lower in patients with T2DM treated with SGLT2i’s compared to sulphonylureas. There was no significant change in eGFR, β-hydroxybutyrate, bicarbonate or anion gap. However, we identified considerable heterogeneity among studies and a lack of head-to-head studies with structured outcome reporting on the risks and benefits of SGLT-2 inhibitors during Ramadan.