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May 7, 2026Journal of Diabetes and Endocrine Practice0 citationsOpen Access

Effectiveness and Safety of Once-Weekly Trelagliptin versus Daily DPP-4 Inhibitors in Fasting People with Type 2 Diabetes during Ramadan

SYSanobia YousufIndus Hospital MAMuhammad Yakoob AhmedaniIndus Hospital

Key Points

Assess the effectiveness and safety of once-weekly trelagliptin versus daily DPP-4 inhibitors in fasting individuals with Type 2 diabetes during Ramadan.
Prospective, interventional, comparative study
Participants randomized into two groups: daily DPP-4 inhibitors or once-weekly trelagliptin
Assessed metabolic, anthropometric measures, and glycemic events pre- and post-Ramadan
In Group A, hypoglycemia occurred in 12.3%, hyperglycemia in 18.5%
In Group B, hypoglycemia was 13.0%, with a better HbA1c reduction of −0.54%
Daily DPP-4 inhibitors and other factors associated with increased adverse events

Abstract

Abstract The objective of this study is to assess the effectiveness and safety of once-weekly trelagliptin versus daily DPP-4 inhibitors in fasting people with Type 2 diabetes during Ramadan. This prospective, interventional, comparative study was conducted at the Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan, between January and April 2024. People with type 2 diabetes mellitus (T2DM) intending to fast were randomized to continue once/twice daily DPP-4i (Group A) or switch to once-weekly trelagliptin 100 mg (Group B). Pre- and post-Ramadan assessments included metabolic and anthropometric measures, medication adherence, dose adjustments, acute glycemic events, and treatment-emergent adverse events (TEAEs) that were recorded using patient logs along with fasting status. A total of 119 fasting people with T2DM were included, with 65 participants in Group A and 54 in Group B. The mean ages were 53.4 ± 9.9 and 52.5 ± 9.4 years, respectively. In Group A, hypoglycemia occurred in 12.3%, hyperglycemia in 18.5%, and TEAEs in 6.1%, with a mean HbA1c reduction of −0.20%. In Group B, hypoglycemia occurred in 13.0%, hyperglycemia in 9.3%, and TEAEs in 3.0%, with a greater reduction in HbA1c (−0.54%, p < 0.0001) post-Ramadan. On multivariate analysis, daily DPP-4 inhibitor use, higher diastolic blood pressure, poor glycemic control, noncompliance, and fewer fasting days were independently associated with adverse events. Trelagliptin showed comparable rates of hypoglycemia, hyperglycemia, and TEAEs, with improved glycemic control and adherence. Transitioning appears to be a safe and effective option for managing T2DM during Ramadan.

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