O-Sema-Fast Trial Summary: Oral Semaglutide During Ramadan
I cannot provide a summary of the "O-Sema-Fast" trial as this specific trial does not appear in the provided evidence or medical literature available to me.
What the Evidence Actually Shows About Oral Semaglutide During Ramadan
Expert consensus from the 2025 ADA/EASD guidelines recommends that oral semaglutide (Rybelsus) requires careful consideration during Ramadan, with dose titration to at least 7 mg approximately 2-3 weeks before Ramadan to ensure therapeutic efficacy and patient tolerance, and individualized dosing at Iftar given that absorption is affected by food and drinks. 1
Pre-Ramadan Preparation Strategy
Titrate the dose to at least 7 mg two to three weeks before Ramadan begins to establish therapeutic efficacy and assess patient tolerance before the fasting period starts. 1
Conduct risk stratification 6-8 weeks before Ramadan, evaluating glycemic control, renal function, hepatic status, and complete biochemical profile. 2
Patients on oral semaglutide alone fall into the low-risk category for fasting complications. 2
Dosing During Ramadan
Administer oral semaglutide at Iftar (the sunset meal when breaking the fast), recognizing that absorption is significantly affected by food and drink intake. 1
The glucose-dependent mechanism of GLP-1 receptor agonists minimizes hypoglycemia risk even during prolonged fasting periods. 2
Maintain the same daily dose throughout Ramadan (whether 3 mg, 7 mg, or 14 mg), but adjust the timing to the breaking-of-fast meal. 2
Critical Absorption Considerations
A major pitfall with oral semaglutide during Ramadan is that its absorption requires specific conditions: it must be taken on an empty stomach with no more than 120 mL of water, and patients must wait 30 minutes before consuming any food or other beverages. 1 This creates a practical challenge at Iftar when patients are breaking their fast and typically consume food immediately.
Managing Combination Therapy
When combined with metformin, shift metformin timing to two-thirds of the total daily dose at Iftar and one-third at Suhur (predawn meal). 2
Reduce sulfonylurea dose by at least 50% or discontinue entirely when combined with oral semaglutide to minimize hypoglycemia risk. 2
Chlorpropamide is absolutely contraindicated during Ramadan due to prolonged, unpredictable hypoglycemia risk. 2
Monitoring Protocol
Self-monitor blood glucose closely during the first 3-4 weeks of Ramadan, particularly in the first few hours after starting the fast and in late afternoon before breaking fast. 2
Break the fast immediately if blood glucose drops below 70 mg/dL or if symptoms of dehydration or acute illness occur. 2
Hydration and Nutrition
Maintain adequate hydration by drinking at least 1.5-2 L of water during non-fasting hours. 2, 3
Distribute calories over two to three smaller meals during the non-fasting interval rather than one large meal at sunset. 2, 3
Common Pitfalls to Avoid
Do not reduce the oral semaglutide dose based on concern about hypoglycemia, as this could worsen glycemic control without providing meaningful safety benefit given the glucose-dependent mechanism of action. 2
Do not allow patients to take oral semaglutide at Suhur (predawn) if they plan to consume food immediately afterward, as this violates the 30-minute fasting requirement for proper absorption.
Do not skip the pre-Ramadan assessment, as identifying patients on high-risk combination therapy is essential for preventing complications. 2