Type 2 diabetic patients who fast during Ramadan experience swings in glycaemic control between hypoglycaemic troughs and hyperglycaemic spikes. Hence, the dual challenge in fasting diabetics is to identify which treatment modality leads to the most stable blood glucose levels during a fast and how to smooth out these excursions and reduce risks of fast to a minimum.

Study Objectives:

• To compare changes in clinical and metabolic parameters from baseline to the end of four weeks fasting in Ramadan between four treatment arms:

  • diet and lifestyle measures alone.
  • metformin monotherapy.
  • combination therapy with metformin + sulfonylurea.
  • combination therapy with metformin + sitagliptin.

• To compare the 24 hour CGMS profile during Ramadan fasting in type 2 diabetic patients before and after addition of acarbose to these pre-existing sub-maximal hypoglycaemic regimens.

Inclusion Criteria:

• HbA1c 6.5-9.5%.
• Type 2 diabetics on two or less oral hypoglycaemic agents.

Exclusion Criteria:

• Any contraindications either to fasting or to any of the trial medication.
• Pregnancy.
• Serum creatinine > 1.4 mg/dl.
• Serum ALT > twice upper limit normal.
• History of pancreatitis, serum amylase > twice upper limit normal.
• History of intolerance to acarbose.