Prospective multicenter real-world study of 109 Bangladeshi T2DM patients prescribed tirzepatide 2.5 mg during Ramadan fasting, evaluating glycemic safety (hypoglycemia rates), glycemic control (HbA1c, fasting and post-iftar glucose), and weight changes during the fasting period. Provides the first dedicated tirzepatide safety data during Ramadan—a physiologically unique context affecting hundreds of millions of patients annually. Establishes tirzepatide's favorable safety and effectiveness profile during Ramadan fasting—addressing a major clinical gap for Muslim patients with T2DM where GLP-1/GIP agonist risk-benefit requires specific evaluation given altered meal timing and fasting physiology.
Abstract
AIMS: Ramadan fasting poses challenges for patients with type 2 diabetes mellitus (T2DM) due to increased risks of hypoglycemia and metabolic fluctuations. Tirzepatide, a dual GIP/GLP-1 receptor agonist, has shown marked efficacy in glycemic control and weight reduction. This study aimed to evaluate the safety and effectiveness of tirzepatide among Bangladeshi patients with T2DM during Ramadan fasting.
METHODS: This prospective, multicentre, real-world evidence study included 109 adult patients with T2DM who intended to fast during Ramadan and were prescribed tirzepatide 2.5 mg weekly, either as monotherapy or in combination with other anti-hyperglycemic agents. Data on glycemic parameters, anthropometrics, blood pressure, lipid profile, renal and liver function were collected at 2-6 weeks before Ramadan and at 2-6 weeks after the end of Ramadan, along with incidences of adverse events. Statistical analysis was performed using SPSS 25.0.
RESULTS: The mean age of the study participants was 40.7 ± 12.8 (SD) years with female predominance (69.7%). About 86.7% of the participants were obese. The mean HbA1c significantly decreased from 7.6% (before Ramadan) to 6.5% (after Ramadan) (mean change: -1.1%; p <0.001). Fasting plasma glucose and 2-h postprandial glucose also showed significant reductions by -2 mmol/L and - 3.8 mmol/L, respectively (both p <0.001). Mean body weight reduction was 5.3 ± 3.9 kg (6.3% of baseline; p <0.001). Mild gastrointestinal events occurred in ~12% of participants, with no hypoglycemia reported.
CONCLUSION: Tirzepatide demonstrated significant improvements in glycaemic control and body weight, with good tolerability, among patients with type 2 diabetes in Bangladesh who fasted during Ramadan.
Authors
Rahman, Muhammad Hafizur; Selim, Shahjada; Afsana, Faria; Hoque, Md Azizul; Saifuddin, M; Alam, Md Shah; Sharifuzzaman, Mirza; Hannan, Mohmmad Abdul; Hasan, Md Nazmul; Kamrul-Hasan, A B M; Mustari, Marufa; Ahammed, Afsar