Related Experiment Video
Updated: Jun 12, 2026

A Method for Mouse Pancreatic Islet Isolation and Intracellular cAMP Determination
Published on: June 25, 2014
GLP-1 receptor agonist adjunct therapy stabilises Ramadan dysglycaemia in insulin-treated diabetes: a CGM-based study
Tanveer Ashraf1, Nader Lessan2
1Clinical Research Fellow, Imperial College London Diabetes and Endocrine Centre (ICLDEC), Abu Dhabi, United Arab Emirates.
Background:
Patients with type 1 and insulin-treated type 2 diabetes are at higher risk of hypo- and hyperglycaemia during Ramadan fasting. The role of incretin-based add-on therapy (GLP-1 receptor agonist semaglutide and the GLP-1/GIP dual agonist tirzepatide) in attenuating Ramadan dysglycaemia in insulin-treated type 2 diabetes has not been characterised using continuous glucose monitoring. Emerging evidence indicates that exaggerated post-iftar hyperglycaemia, drives Ramadan dysglycaemia in insulin-treated individuals.
Aims:
To use continuous glucose monitoring (CGM) to characterise glycaemic control in patients with type 1 and type 2 diabetes on intensive insulin during Ramadan fasting, and to evaluate the role of add-on semaglutide or tirzepatide in attenuating post-iftar hyperglycaemia.
Methods:
Adults with type 1 or type 2 diabetes using FreeStyle Libre CGM who completed ≥ 14 full fasting days during Ramadan 2025 were included. Of 140 participants screened pre-Ramadan, 54 met all inclusion criteria and were analysed: type 2 diabetes on basal-bolus insulin alone (BB, n = 18), type 2 diabetes on basal-bolus plus tirzepatide or semaglutide (BB+, n = 18) - matched 1:1 by age, baseline HbA1c and BMI - and type 1 diabetes on basal-bolus insulin (T1DM, n = 18). CGM metrics were collected over 28 days pre-Ramadan (1-28 February 2025) and 29 days during Ramadan (1-29 March 2025) and compared within and between groups, and across fasting versus non-fasting windows.
Results:
Dysglycaemia was driven predominantly by the post-iftar period. BB participants showed marked deterioration during non-fasting hours. Adjunctive therapy attenuated this effect: time in range 74.4 % vs 36.8 % (p = 0.007), glucose management indicator 6.9 % vs 8.3 % (p = 0.004), and > 2-fold (≈61 %) reduction in incremental post-iftar area under the curve (102,014 vs 260,578 mg/dL·min over the 4-h post-iftar window).
Conclusion:
In matched insulin-treated type 2 diabetes cohorts, add-on semaglutide or tirzepatide stabilised Ramadan glycaemia and reduced post-iftar hyperglycaemia without increasing hypoglycaemia, and was well tolerated with no treatment discontinuations during Ramadan.
Related Concept Videos
Glucagon-like Receptor Agonists
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by the...
Oral Hypoglycemic Agents: Glinides
Dipeptidyl Peptidase 4 Inhibitors
Oral Hypoglycemic Agents: α-Glucosidase Inhibitors
Acarbose and miglitol are typically...
Insulin: Dosing Regimen and Adverse Effects
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
Oral Hypoglycemic Agents: Biguanides and Glitazones
