Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Dec 20, 2025; 15(4): 105478
Published online Dec 20, 2025. doi: 10.5662/wjm.v15.i4.105478
Safety and efficacy of glucagon-like peptide-1 receptor agonists in individuals with type 2 diabetes mellitus fasting during Ramadan: a systematic review and meta-analysis
Abul Bashar Mohammad Kamrul-Hasan, Joseph M Pappachan, Hamid Ashraf, Lakshmi Nagendra, Deep Dutta, Mohammad Shafi Kuchay, Shehla Shaikh
Abul Bashar Mohammad Kamrul-Hasan, Department of Endocrinology, Mymensingh Medical College, Mymensingh 2200, Bangladesh
Joseph M Pappachan, Faculty of Science, Manchester Metropolitan University, Manchester M156BH, United Kingdom
Joseph M Pappachan, Department of Endocrinology, Kasturba Medical College, Manipal and Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
Hamid Ashraf, Rajiv Gandhi Centre for Diabetes and Endocrinology, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India
Lakshmi Nagendra, Department of Endocrinology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, 570004, India
Deep Dutta, Department of Endocrinology, CEDAR Superspeciality Healthcare, New Delhi 110075, India
Mohammad Shafi Kuchay, Department of Endocrinology and Diabetes, Medanta-The Medicity Hospital, Gurugram 122001, Haryana, India
Shehla Shaikh, Department of Endocrinology, Sir H.N. Reliance Foundation Hospital and Research Centre, Mumbai 400004, India
Author contributions: Kamrul-Hasan ABM and Pappachan JM were responsible for the integrity of the work as a whole; Kamrul-Hasan ABM, Pappachan JM, and Dutta D evaluated the quality of the literature; Kamrul-Hasan ABM, Ashraf H, Kuchay MS, and Shaikh S wrote the draft; Kamrul-Hasan ABM, Ashraf H, and Nagendra L collected and analyzed the data and drew the tables and figures; Kamrul-Hasan ABM and Kuchay MS conceptualized and designed the study; Pappachan JM, Nagendra L, and Dutta D reviewed and revised the manuscript; Pappachan JM and Shaikh S adjudicated any disagreements; Ashraf H, Nagendra L, Dutta D, and Shaikh S performed the full-text review and data identification; each author made contributions to the article and endorsed the submitted version; all of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: There are no conflicts in interest among authors.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joseph M Pappachan, MD, FRCP, Professor, Senior Researcher, Faculty of Science, Manchester Metropolitan University, All Saints Building, Manchester M156BH, United Kingdom. drpappachan@yahoo.co.in
Received: January 24, 2025
Revised: April 17, 2025
Accepted: June 3, 2025
Published online: December 20, 2025
Processing time: 193 Days and 4.6 Hours
Abstract
BACKGROUND

Data on the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in individuals with type 2 diabetes mellitus (T2DM) during Ramadan fasting is limited. No meta-analysis has summarized the safety and effectiveness of GLP-1RAs in these situations.

AIM

To evaluate the safety and efficacy of GLP-1RA in patients with T2DM fasting during Ramadan.

METHODS

Electronic databases were systematically searched for relevant studies that featured GLP-1RA in the intervention arm and other glucose-lowering medications in the control arm. The primary outcome was adverse events (AEs) during Ramadan for both groups; other outcomes included changes in glycemic and anthropometric measures during the peri-Ramadan period.

RESULTS

Four studies [three randomized-controlled trials with low risk of bias (RoB) and one prospective observational study with serious RoB] involving 754 subjects were analyzed. GLP-1RA group achieved greater glycated hemoglobin reduction than the non-GLP-1RA group [mean difference (MD): -0.31%, 95%CI: -0.61 to -0.01, P = 0.04, I2 = 77%] with a lower risk of documented symptomatic hypoglycemia (risk ratio = 0.38, 95%CI: 0.16 to 0.88, P = 0.02). Any AEs, serious AEs, or AEs that led to treatment discontinuation were comparable between the two groups. The GLP-1RA group experienced greater weight loss compared to the non-GLP-1RA group (MD: -2.0 kg, 95%CI: -3.37 to -0.63, P = 0.004, I2 = 95%). There were comparable changes in blood pressure and lipid profile between the two groups. GLP-1RA users experienced higher risks of gastrointestinal AEs, nausea, and vomiting; however, the risks of heartburn, abdominal pain, and diarrhea were similar in both groups.

CONCLUSION

Limited evidence suggests that GLP-1RAs are safe for T2DM management during Ramadan, offering modest benefits in blood sugar control and weight loss. Large multicenter trials are needed to confirm their safety and efficacy in at-risk populations, improving clinical practice decision-making.

Keywords: Type 2 diabetes mellitus; Glucagon-like peptide-1 receptor agonist; Ramadan; Religious fasting; Safety; Meta-analysis

Core Tip: No systematic review and meta-analysis (SR/MA) have previously assessed the safety and efficacy of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in individuals with type 2 diabetes mellitus who fast during Ramadan. This SR/MA of 4 studies with 754 participants identified that GLP-1RAs are safe with only exaggerated gastrointestinal side effects, mainly nausea and vomiting. GLP-1RA also appears to be effective in improving glycated hemoglobin and aiding in weight loss, compared to other glucose-lowering medications. However, other cardiometabolic benefits, such as improvements in blood pressure and lipid profile, were not evident. Larger multinational, randomized trials with broader global participation are needed to establish more definitive clinical practice recommendations for using GLP-1RAs during Ramadan fasting.