Semaglutide or Tirzepatide Adjunct Therapy Stabilizes Ramadan Dysglycaemia in Insulin-Treated Type 2 Diabetes
Background
Patients with type 1 and insulin-treated type 2 diabetes face heightened risks of both hypoglycaemia and hyperglycaemia during Ramadan fasting, particularly driven by exaggerated post-iftar glucose spikes. Current standard-of-care often struggles to maintain stable glycaemic control in this unique fasting context. The role of incretin-based add-on therapies, specifically GLP-1 receptor agonists like semaglutide and dual GLP-1/GIP agonists like tirzepatide, in mitigating this dysglycaemia in insulin-treated individuals has not been thoroughly characterized using continuous glucose monitoring (CGM). This study aimed to fill that gap by evaluating their impact on post-iftar hyperglycemia.
Study Design
Researchers conducted a CGM-based observational study involving 54 adults who completed at least 14 full fasting days during Ramadan 2025. Participants were categorized into three matched groups (n=18 each): type 2 diabetes on basal-bolus insulin alone (BB), type 2 diabetes on basal-bolus insulin plus semaglutide or tirzepatide (BB+), and type 1 diabetes on basal-bolus insulin (T1DM). Groups were 1:1 matched by age, baseline HbA1c, and BMI. CGM metrics were collected over 28 days pre-Ramadan and 29 days during Ramadan, comparing glycaemic control within and between groups, and across fasting versus non-fasting windows.
Results
Dysglycaemia during Ramadan was primarily driven by the post-iftar period. Participants on basal-bolus insulin alone (BB group) showed a marked deterioration in glycaemic control during non-fasting hours. However, the adjunctive therapy group (BB+), receiving semaglutide or tirzepatide, significantly attenuated this effect. The BB+ group demonstrated superior time in range (TIR), achieving 74.4% compared to 36.8% in the BB group (p=0.007). Their glucose management indicator (GMI) was also significantly better at 6.9% versus 8.3% (p=0.004).
Key Findings
- Dysglycaemia during Ramadan fasting was predominantly driven by the post-iftar period.
- Insulin-treated type 2 diabetes patients on basal-bolus alone (BB) showed marked glycaemic deterioration during non-fasting hours.
- Adjunctive semaglutide or tirzepatide (BB+) significantly improved
time in rangeto 74.4% vs 36.8% in BB (p=0.007). - BB+ group achieved a better
glucose management indicatorof 6.9% vs 8.3% in BB (p=0.004). - Adjunctive therapy led to a >2-fold (≈61%) reduction in incremental post-iftar
AUC.
Why It Matters
This study provides crucial CGM-based evidence supporting the use of GLP-1 receptor agonists or GLP-1/GIP dual agonists as adjunct therapy for insulin-treated type 2 diabetes patients fasting during Ramadan. The findings suggest that adding semaglutide or tirzepatide can significantly stabilize blood glucose, particularly by mitigating the exaggerated post-iftar hyperglycaemia that often complicates Ramadan fasting. This could lead to safer and more effective diabetes management protocols during this period, potentially reducing the risk of acute complications like severe hypo- or hyperglycaemia. For individuals managing their diabetes, incorporating these peptides could offer a more stable and less restrictive fasting experience, improving overall quality of life and adherence to religious practices without compromising health.
semaglutide
tirzepatide
type-2-diabetes
ramadan
cgm
glp-1-agonist