The Indian phenotype of T2DM patients is
associated with clustering of cardiovascular risk factors, increased insulin
resistance, and reduced beta-cell function. In India, various cost-effective, generic FDCs of
DPP4i-SGLT2is are available for T2DM management. Hence, investigators conducted
this knowledge, attitude, and practice (KAP) survey to study the practical use
of SGLT2i-DPP4i FDCs in Indian settings.Part of these survey findings were presented at the American Diabetes Association (ADA) 2024 Congress held in Orlando, Florida.

Results:

Total 185 physicians from multiple states of India
completed the survey In Indian Clinical Practice, there is a
significant burden of patients with T2DM who present with high baseline HbA1c
(newly diagnosed treatment naive or despite metformin monotherapy) 48% physicians reported that more than 40% of
their newly diagnosed, treatment-naive patients present with a baseline HbA1c
>8%52% physicians reported that, more than 40% of
patients present with HbA1c >8.5% despite metformin monotherapy

Generic DPP4i/SGLT2i FDCs were preferred in
these patients also considering their extra-glycemic benefits. 60.5% (n=112) respondents prescribe these FDCs
due to all four clinical reasons namely:-CV benefits of SGLT2i are an added advantage in
Indian population (since Indian patients often have clustering of multiple CV
risk factors).Targets multiple pathways in ominous octet.FDCs promotes weight loss.Significantly lesser risk of hypoglycaemia
compared to sulfonylurea (SU) based FDCs.From a glycemic control perspective, 65.9%
of respondents preferred DPP4i–SGLT2i FDCs for below 3 scenarios, namely:Treatment-naive
patients with contraindication/ intolerance to metformin and HbA1c >8%.Uncontrolled
on metformin monotherapy with HbA1c >8.5%.As add-on to insulin.Unique Finding – Most physicians (85%) noted
reduction in SGLT2i associated Genito-Urinary Tract Infections (GUTIs) with use
of DPP4i/SGLT2i FDCs or concomitant administration of both agents. Further well designed studies may confirm this
findingAmongst the
DPP4i/SGLT2i FDCs available in India, most physicians preferred
Sitagliptin/Dapagliflozin as FDC of choice. Sita-Dapa was the most preferred
FDC (36.2% respondents) of respondents (n=67).

Takeaways:

Indian phenotype is associated with
clustering of CV risk factors like HTN, dyslipidemia, and abdominal obesity
which lead to early atherosclerotic cardiovascular disease compared to
Caucasian populations.Hence,
management of T2DM in India warrants early
consideration of therapies that confer CV protection (e.g., SGLT2i) at the time
of diagnosis itself. Studies have demonstrated that in global
reference populations, patients with diabetes have already lost approximately
50% of their β-cell mass at the time of diagnosis itself. Also South Asian
phenotype has reduced baseline β-cell function vs population groups.This
further underscores the need for
considering agents that preserve β-cell function (e.g., DPP4is) early in the
course of diabetesThis pan-India survey also highlights
that patients with T2DM often present with a high baseline HbA1c in the Indian
physician’s clinic. SGLT2i-DPP4i FDCs satiate an important gap whereby current
guidelines recommend initiating dual-combination therapy when target HbA1c is
>1.5% compared to baseline HbA1c.

Reference: Saboo B, Prajapati C, Muralidharan P, et
al. DiSi Survey: Use of Generic DPP4i–SGLT2i Fixed-dose Combinations in Indian
Clinical Practice. J Assoc Physicians India 2024;72(12):22–24