Diabetes Obes MetabType 2 DiabetesCohortDecember 4, 2025

Safety and effectiveness of tirzepatide during Ramadan fasting: Real-world evidence from patients with type 2 diabetes in Bangladesh.

Rahman MH, Selim S, Afsana F, Hoque MA, Saifuddin M, Alam MS, Sharifuzzaman M, Hannan MA, Hasan MN, Kamrul-Hasan ABM, Mustari M, Ahammed A

View on PubMed DOI: 10.1111/dom.70343

Key Finding

Bangladeshi patients with type 2 diabetes lost 6.3% of their body weight and dropped their HbA1c from 7.6% to 6.5% while taking tirzepatide during Ramadan fasting, with no cases of dangerous low blood sugar.

What This Study Found

This study followed 109 Bangladeshi patients with type 2 diabetes who were taking tirzepatide (a dual-action diabetes medication) while observing Ramadan fasting - imagine trying to manage your blood sugar while your eating schedule completely flips upside down for a month. Think of tirzepatide as a smart traffic controller for your blood sugar and appetite: it tells your body to release insulin when needed and slows down digestion to prevent sugar spikes. During this challenging fasting period, patients didn't just maintain their health - they actually improved dramatically. Their average blood sugar control (HbA1c) dropped by 1.1 percentage points, which is like going from a B- grade to an A- in diabetes management. The weight loss was substantial too - patients shed an average of 5.3 kg (about 12 pounds), which represents 6.3% of their starting weight. Most remarkably, despite the irregular eating patterns during Ramadan, not a single patient experienced hypoglycemia (dangerously low blood sugar), and only 12% had mild stomach upset.

Statistics Decoded

HbA1c drop of 1.1% (from 7.6% to 6.5%): This is like upgrading your 3-month blood sugar report card from 'needs improvement' to 'good control' - anything under 7% is the goal for most diabetics. Fasting glucose dropped by 2 mmol/L and post-meal glucose by 3.8 mmol/L: Think of these as your blood sugar 'before breakfast' and 'after dinner' readings getting much closer to normal. Weight loss of 5.3 kg (6.3% of body weight): For a 200-pound person, this would be about 12.6 pounds lost. The p <0.001 for all these changes means there's less than a 0.1% chance these improvements happened by luck - like correctly guessing a 4-digit PIN on your first try.

Why This Matters

This breaks new ground by showing that tirzepatide is not just safe during Ramadan fasting, but actually helps diabetic patients thrive during this challenging period when blood sugar swings and medication timing become much more complex. For the millions of Muslims with diabetes worldwide, this provides strong evidence that they can safely observe their religious practices while achieving excellent diabetes control.

Original Abstract

Ramadan fasting poses challenges for patients with type 2 diabetes mellitus (T2DM) due to increased risks of hypoglycemia and metabolic fluctuations. Tirzepatide, a dual GIP/GLP-1 receptor agonist, has shown marked efficacy in glycemic control and weight reduction. This study aimed to evaluate the safety and effectiveness of tirzepatide among Bangladeshi patients with T2DM during Ramadan fasting. This prospective, multicentre, real-world evidence study included 109 adult patients with T2DM who intended to fast during Ramadan and were prescribed tirzepatide 2.5 mg weekly, either as monotherapy or in combination with other anti-hyperglycemic agents. Data on glycemic parameters, anthropometrics, blood pressure, lipid profile, renal and liver function were collected at 2-6 weeks before Ramadan and at 2-6 weeks after the end of Ramadan, along with incidences of adverse events. Statistical analysis was performed using SPSS 25.0. The mean age of the study participants was 40.7 ± 12.8 (SD) years with female predominance (69.7%). About 86.7% of the participants were obese. The mean HbA1c significantly decreased from 7.6% (before Ramadan) to 6.5% (after Ramadan) (mean change: -1.1%; p <0.001). Fasting plasma glucose and 2-h postprandial glucose also showed significant reductions by -2 mmol/L and - 3.8 mmol/L, respectively (both p <0.001). Mean body weight reduction was 5.3 ± 3.9 kg (6.3% of baseline; p <0.001). Mild gastrointestinal events occurred in ~12% of participants, with no hypoglycemia reported. Tirzepatide demonstrated significant improvements in glycaemic control and body weight, with good tolerability, among patients with type 2 diabetes in Bangladesh who fasted during Ramadan.