In Bangladeshi adults with type 2 diabetes who fasted for Ramadan, a low weekly dose of tirzepide (2.5 mg) safely lowered blood sugar and cut body weight by about 5 kg, with only mild stomach upset and no dangerous low‑blood‑sugar episodes.

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.