Glycaemic Variability with Dapagliflozin Compared to Saxagliptin in Type 2 Diabetic Patients during Ramadan Fasting
Presentation Number: SUN 624
Date of Presentation: April 2nd, 2017
Hospital Putrajaya, Putrajaya, MALAYSIA
Introduction: Fasting during Ramadan among Type 2 Diabetes (T2DM) have been associated with glycaemic excursions, with increased frequency of hypoglycaemia and hyperglycaemia. The choice of medications used during fasting is important to avoid these complications. Continous Glucose Monitoring (CGMS) is a useful tool to measure glycaemic variability. To date there was no study describing glycaemic variability in Ramadan fasting with Dapagliflozin and Saxagliptin.
Objective: To compare the glycaemic variability of Type 2 diabetic patients on Dapagliflozin and Saxagliptin during Ramadan fasting
Methods: This is a pilot, randomized, open-label study, two-arm parallel group involved T2DM patients on Metformin monotherapy. 28 subjects were randomized to either T. Dapagliflozin 10mg od or T. Saxagliptin 5mg od. They were randomized 11 weeks before Ramadan from 1 April 2015 and continued till 17 July 2015 with a total of 20 weeks duration. Blood parameters including fasting serum lipid, fasting blood sugar, HbA1c, serum fructosamine, renal profile, liver function test, full blood count and urine FEME were taken at baseline, 2-weeks before Ramadan and 2-weeks before end of Ramadan. Patients will be given an activity log and instructed to document their activities including meals, days of fasting, activities and hypoglycaemia events. Continuous glucose monitoring was inserted before Ramadan and before end of Ramadan for three days. Glycaemic variability were analyzed using EasyGV software that calculate MAGE, to assess intraday variability, M-value that expressed mean glucose value and the effect of glucose swing. HBGI and LBGI are parameter used to assess risk of hyperglycaemia and hypoglycaemia.
Results: 11 subjects were randomized to Saxagliptin arm and 14 subjects were on Dapagliflozin arm. At baseline, the mean HbA1c in Saxagliptin plus Metformin was 7.69% (0.93) while in Metformin plus Dapagliflozin was 8.42%(1.56) At end of week 20, HbA1c level was 6.96% (0.88) in Saxagliptin plus Metformin while in Dapagliflozin plus Metformin was 7.65%(1.17). M-Value in the Metformin plus Dapagliflozin arm showed a significant reduction during Ramadan [7.08(5.22) vs. 3.73(2.34) p=0.019] while in Metformin plus Saxagliptin, there was no significant reduction [6.22(5.83) vs. 4.68(4.72) p=0.453]. Risk of hypoglycaemia was lower in Dapagliflozin plus Metformin but it was not statistically significant (p=0.276). HBGI an indicator of hyperglycaemia risk was significantly lower in Metformin plus Dapagliflozin arm (p=0.023). However, when the 2 groups were compared, there were no significant differences in glycaemic variability pre-Ramadan and during Ramadan fasting.
Conclusion: Dapagliflozin in Ramadan illustrate a better glycaemic excursion compared to Saxagliptin
Nothing to Disclose: YY