Vol 11, No 4 (2022)
Observation letter
Published online: 2022-08-31

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Clinical Outcomes of IDF-DAR Practical Guidelines Adaptation for the Management of Type 2 Diabetes: Results from a Real-world Clinical Study in India

Supratik Bhattacharyya1
Clin Diabetol 2022;11(4):298-299.


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ISSN 2450–7458

e-ISSN 2450–8187

Clinical Outcomes of IDF-DAR Practical Guidelines Adaptation for the Management of Type 2 Diabetes: Results from A Real-world Clinical Study in India

Supratik Bhattacharyya1
1Department of Endocrinology, Apollo Clinic, Kolkata, India

Address for correspondence:

Supratik Bhattacharyya

Department of Endocrinology, Apollo Clinic

Kolkata, India

phone: +919007498749

e-mail: dr_supratik@yahoo.co.uk

Clinical Diabetology 2022, 11; 4: 298–299

DOI: 10.5603/DK.a2022.0034

Received: 8.07.2022 Accepted: 26.07.2022


Nearly half a billion people currently live with diabetes worldwide (India: 77 million people) according to the International Diabetes Federation (IDF), and this can reach 700 million by 2045 [1–3]. Almost 79–94% of Muslims with type 2 diabetes mellitus (T2DM) fast (without food/water) during Ramadan, which increases the risk of hypoglycemia [1]. T2DM accounts for 90% of all diabetes cases worldwide. The IDF-DAR guidelines suggest that chances of hypoglycemia can be reduced [1–3]. Thus, we assessed the impact of adaptation of IDF-DAR on the risk of hypoglycemia and glycemic control in patients with T2DM fasting during Ramadan.

Materials and methods

This retrospective observational study investigated 30 out-patients (aged ≥ 18 years; mean age: 54.26 ± ± 12.02 years) with T2DM of a tertiary super-specialty hospital in Kolkata who fasted during Ramadan. Patients were given basal insulin (unit dose per the patient profile) and gliclazide XR 60 mg-based regimen (n = 13 with 500 mg, n = 9 with 1000 mg, and n = 5 with 2000 mg metformin, and n = 3 without metformin) at Iftar instead of breakfast. This study was approved by the ethics committee. Occurrence of hypoglycemic events and change in glycemic parameters were the outcomes to measure glycemic control. Occurrence of hypoglycemic events was reported as per their severity and documented as overall (n = 2)/daytime (n = 2)/nighttime (n = 0) hypoglycemia. Two patients experienced episodes of minor symptomatic hypoglycemia during daytime. Mean HbA1c levels decreased from 7.92 ± 1.49% at pre-Ramadan visit to 7.32 ± 0.82% at post-Ramadan visit. Glycemic control was maintained with mean reductions in HbA1c levels (–0.60 ± 0.86%) with gliclazide XR 60 mg regimen (Fig. 1).

Figure 1. Change in HbA1c Pre- and Post-Ramadan
HbA1c glycated hemoglobin; MD — mean difference


Individualized treatment and counseling minimized actual and/or perceived hypoglycemic events and prevented severe hypoglycemia during Ramadan. Patients were educated on hypoglycemia awareness and advised to change their dosage time from breakfast to Iftar, which helped minimize hypoglycemic events during Ramadan.

Sulfonylureas are widely used after metformin in patients with T2DM in India, and IDF-DAR recommends switching patients to newer sulfonylureas, such as gliclazide XR [4]. The DIA-RAMADAN study also reported better glycemic control when gliclazide was administered at Iftar and fewer hypoglycemia cases [5]. Thus, adapting recommendations from IDF-DAR practical guidelines by shifting gliclazide XR 60 mg-based regimen to Iftar was feasible, resulted in lowered rates of hypoglycemia, and persistently improved glycemic control in real-world settings.


This publication was prepared without any external source of funding.


The author acknowledges CBCC Global Research for providing scientific writing assistance for the development of this manuscript.

Conflict of interest

None declared.


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