Safety Assessment of Glucose-Lowering Drugs and Importance of Structured Education during Ramadan : A Systematic Review and Meta-Analysis

Background. Ramadan is the sacred month of the Islamic Hijri (lunar) calendar, and during this entire month, healthy adult Muslims abstain from eating and drinking from dawn to sunset. Muslims with Type 2 Diabetes Mellitus (T2DM) who choose to fast during Ramadan encounter major risks such as hypoglycemia, hyperglycemia, diabetic ketoacidosis, dehydration, and thrombosis. Although patients with poor glycemic control and on multiple insulin injections are at high risk and exempt from fasting, many still insist on it. Thus, healthcare professionals play a pivotal role in managing diabetes-related complications in patients who fast during Ramadan. However, there is a lack of standard guidelines to be followed in association with structured education and administration of drugs and dosage. Therefore, we performed a systematic review and meta-analysis of the literature to determine the safety and efficacy of different classes of drugs and the importance of structured education during Ramadan. Methods. In this review, an extensive PubMed search was performed to obtain literature on T2DM patients who fast during the month of Ramadan until the year 2020. Preference was given to fully downloadable articles. The articles were extracted based on the eligibility criteria. The extracted data were analyzed using Review Manager software version 5.3. Results. A total of 32 articles were included for the review and 7 studies for meta-analysis. Majority of the studies demonstrated the importance of structured education either as a group session or as a one-on-one session with the healthcare professionals in preventing diabetes-related risks during Ramadan. As far as glucose-lowering drugs are concerned, DPP-4 inhibitor combined with metformin remains the drug of choice for T2DM patients who fast during Ramadan. The newer class of glucose-lowering agents appear to lower the risk of hypoglycemia in comparison with sulphonylureas, while among sulphonylureas gliclazide is relatively safe. The meta-analysis indicates that DPP-4 inhibitors would significantly reduce the risk of hypoglycemia as compared to sulphonylurea (odds ratio=0.38, 95% CI: 0.26 to 0.55, p < 0.00001). Conclusion. The results of our systematic review show that structured education and counselling by healthcare professionals can be an effective tool in preventing complications associated with fasting during Ramadan in people with T2DM. Additionally, the safest class of oral glucose-lowering drugs preferred during Ramadan fasting in T2DM patients is DPP-4 inhibitors.Peer reviewe

Effect of Samarium Substitution on the Structural and Magnetic Properties of Nanocrystalline Cobalt Ferrite

A series of samarium-substituted cobalt ferrites (CoFe2−xSmxO4 with x=0.00, 0.05, 0.10, 0.15, 0.20, 0.25) was synthesized by the sol-gel method. The structural characterizations of all the prepared samples were done using XRD and FTIR. These studies confirmed the formation of single-phase spinel structure in all the compositions. The increase in the value of lattice parameter with increase in samarium concentration suggests the expansion of unit cell. The Hall-Williamson analysis is used for estimating the average crystallite size and lattice strain induced due to the substitution of samarium in the prepared samples. Crystallinity and the crystallite size are observed to increase with the concentration of samarium. The surface morphology and particle size of a typical sample were determined using SEM and TEM respectively. The substitution of samarium strongly influences the magnetic characteristics, and this is confirmed from the magnetization measurements at room temperature