Expert opinion on fixed-dose combinations of sitagliptin + dapagliflozin and the triple drug combination of dapagliflozin + sitagliptin + metformin in the management of type 2 diabetes mellitus in Indian settings

Abstract

To gather clinicians' perspectives regarding the prescription practice of the fixed-dose combinations (FDC) of sitagliptin + dapagliflozin and the triple drug combination of dapagliflozin + sitagliptin + metformin for managing type 2 diabetes mellitus (T2DM) in Indian settings. Methodology:The cross-sectional survey, gathered the opinions of clinicians across India using a multiple-response questionnaire comprising 22 questions. The survey focused on garnering insights, clinical observations, and experiences related to the utilization of FDCs for the management of T2DM. Descriptive statistics were employed for data analysis, depicting categorical variables as percentages. Graphical representations were created using Microsoft Excel 2013. Results:The respondents predominantly recommended sitagliptin and dapagliflozin FDC therapy for T2DM patients with comorbidities such as hypertension and vascular diseases, leading to non-glycemic benefits like reduced body weight, blood pressure, and increased vasodilation. Around 82% of the clinicians favored this FDC therapy due to its superior cardiovascular and renal safety profile. Notably, 41% of clinicians suggested benefits for patients with an initial HbA1c level of 8%. The majority indicated preference for patients with atherosclerotic cardiovascular disease (31%) and chronic kidney disease up to stage 3 (28%). Clinicians reported reduced glycemic variability (65%), lower risk of urinary tract infections (74%), and a significant body weight reduction (44%) with the therapy. According to 63% of the clinicians, sitagliptin, dapagliflozin, and metformin FDC therapy decreases endogenous glucose production. The majority (44%) of the clinicians reported 2-3 kg body weight reduction with this therapy in T2DM individuals, and attainment of rapid and sustained glycemic goals (47%). Conclusion: Majority of the clinicians endorsed sitagliptin and dapagliflozin FDC for managing T2DM, citing non-glycemic benefits, superior cardiovascular safety, and positive outcomes in patients with specific comorbidities. Survey respondents also recommend the sitagliptin, dapagliflozin, and metformin FDC, highlighting its effectiveness in reducing endogenous glucose production, inducing significant body weight reduction, and facilitating the attainment of rapid, sustained glycemic goals.