Table 1

Recommended medical therapy changes during Ramadan for patients with type 2 diabetes

Prior to Ramadan	During Ramadan
Metformin	No change in total daily dose.
Once a day	Usual dose at Iftaar meal.
Twice a day	Usual dose at Iftaar and Suhoor.
Three times a day	Combine the lunch time dose with Iftaar meal and take the morning dose at Suhoor.
Slow release formulation	Take at Iftaar.
SGLT2i	No dose change is usually required but patients should be well established on these prior to start of Ramadan. Ensure adequate hydration and take usual dose with Iftaar meal. We do not recommend starting it as a new medication immediately prior to or during Ramadan.
GLP-1RA	No dose change is usually required but patients should be established on a stable tolerated dose a few weeks prior to start of Ramadan. If not tolerated, either reduce the dose or stop the GLP-1RA, especially if nausea or vomiting.
DPP4 inhibitor	No dose change is usually required but consider reducing the dose of concomitant SU or stopping SU.
TZD	No dose change is usually required. Taken with either Iftaar or Suhoor, preferably with the larger meal, which is usually Iftaar meal. It will take 10–12 weeks for maximal effect, therefore consider starting a few weeks prior to start of Ramadan. Reduce the dose or stop SU if concomitant use.
SU	Consider either substituting, stopping or reducing the dose.
Once a day	Take the usual dose at Iftaar meal.
Twice a day	Usual dose at Iftaar meal and 50% of the usual dose with Suhoor meal.

DPP4, dipeptidyl peptidase-4 ; GLP-1RA, glucagon-like peptide-1 receptor agonists; SGLT2i, sodium-glucose cotransporter-2 inhibitors; SU, sulfonylureas; TZD, thiazolidinedione.