Table 1

Pharmacological oral agents for the treatment of type 2 diabetes during Ramadan

Generic nameDaily dosage (mg)AdvantagesConcerns
Insulin secretagogues
 Glipizide2.5–20Lowers HbA1c by 1–2%, high initial response rate, no lag time before response, once-daily dosing, low costHypoglycemia, weight gain, need caution in patients with renal and hepatic dysfunction and with sulfa allergy
 Gliclazide MR30–60
 Repaglinide0.5–8Lowers HbA1c by 1–1.5%, shorter half-life than sulfonylureasHypoglycemia, weight gain, repeated (before meals) dosing, more expensive than sulfonylureas
α-Glucosidase inhibitors
 Acarbose25–150Lowers HbA1c by 0.5–0.8% lowers postprandial glucose levels without causing hypoglycemia, weight neutralLess effective in lowering glycemia than metformin or sulfonylureas, increased gas production and GI symptoms
Insulin sensitizers
 Metformin500–2000Lowers HbA1c by 1–2%,weight neutral, high initial response rate, long record of relative safety, low risk of hypoglycemia, improved lipid profile, may reduce macrovascular events, low costInitial GI side effects common, risk of lactic acidosis, cannot be used in patients with renal dysfunction or hepatic dysfunction
 Pioglitazone15–45Lowers HbA1c by 0.8–1.5%, low risk of hypoglycemia, improved lipid profileWeight gain, fluid retention causing peripheral edema and/or heart failure, expensive, risk of osteopenia in postmenopausal females
Incretin agents
Dipeptidyl peptidase-4 inhibitors
 Sitagliptin25–100Lowers HbA1c by 0.6–1%, well tolerated, lowers postprandial glucose levels, weight neutralMore expensive and less potent than metformin and sulfonylureas, some agents require dose adjustment in patients with reduced renal function
Glucagon-like peptide 1 agonists
 Exenatide5–10 mcg two times a dayLowers HbA1c by 0.8–2%, lowers postprandial glucose levels, weight loss, low risk of hypoglycemia, may reduce blood pressure, improved lipid profileHigh rate of GI side effects, injectable, more expensive than sulfonylureas and metformin
 Liraglutide0.6–1.8 mg daily
 Exenatide ER2 mg weekly
 Dulaglutide0.75–1.5 mg weekly
 Albiglutide30 mg weekly
 Lixisenatide*10 mcg daily
SGLT-2 inhibitors
 Dapagliflozin5–10 mg dailyLowers HbA1c by 0.8–1.5%, low risk of hypoglycemia, weight loss, lower blood pressureIncreases risk of urinary tract infection and genital infections, expensive, risk of dehydration
 Canagliflozin100–300 daily
  • *Not Food and Drug Administration approved. ER, extended release; GI, glycemic index; HbA1c, glycated hemoglobin; MR, modified release; SGLT-2, sodium glucose transporter-2.