Table 6.
| Glucose-lowering Therapy | Recommendation during Ramadan Fasting | Recommendation during COVID-19 |
|---|---|---|
| Metformin | No dose modification required for OD and BD dose. For TID dosing, one dose after suhoor and remaining two doses together after Iftar. | Stop Metformin.in COVID-19 positive with severe symptoms, poor oral intake, risk of dehydration and AKI |
| First line glucose lowering therapy | ||
| Low risk of hypoglycemia | ||
| Insulin | Avoid Glibenclamide due to high risk of hypoglycemia | Dose reduction may be needed depending on blood sugar levels |
| Secretagogues | Glimepiride, Gliclazide can be used | |
| OD dose: take at Iftar | ||
| BD dose: Iftar dose remains the same, Suhoor dose should be halved | ||
| Repaglinide: take before meals | ||
| DPP-4 inhibitors and AGI | No dose modification required | No dose modification |
| Low risk of hypoglycaemia | ||
| SGLT-2 inhibitors | No dose modification required usually | COVID -19 with severe symptoms -stop the drug. COVID -19 with no/mild symptoms -Dose modification to be considered. |
| Low risk of hypoglycaemia | ||
| Fix stable dose 4 weeks before Ramadan | ||
| Thiazolidinediones | No dose modification required | No dose modification |
| Low risk of hypoglycaemia | ||
| Hydroxychloroquine (insufficient data) | Low risk of hypoglycemia but dose of concomitant drug needs to be reduced | Hypoglycemia risk (along with few drugs) |
OD: Once daily, BD: Twice daily, TID: Thrice daily, AKI: Acute kidney injury, DPP4: Dipeptidyl peptidase 4, AGI: Alpha Glucosidase inhibitors, SGLT-2: Sodium Glucose co-transporter-2. Adapted from: ADA 2020, IDF 2016, IGDR 2015, IDF-DAR Practical Guidelines, South Asian Consensus Guidelines.