Vol. 6, Issue 1, Part A (2024)

Objective: The current survey-based study aims to gather expert opinion regarding the prescription practice of triple combination oral antidiabetic (OAD) treatment for the management of uncontrolled type 2 diabetes mellitus (T2DM) with a special focus on vildagliptin + dapagliflozin + metformin in Indian settings. 
Methodology: The cross-sectional survey utilized a 25-item, multiple-response questionnaire to gather expert opinions from specialists with expertise in managing diabetes. The survey encompassed questions pertaining to current prescription practices, clinical observations, preferences, and experiences related to the use of vildagliptin + dapagliflozin + metformin in routine settings for diabetes management.
Results: About 65% of clinicians preferred initiating gliptin + SGLT2i + metformin as a triple-drug fixed OAD combination therapy. According to 28% of the clinicians, the major advantage of the fixed-dose combination of dipeptidyl peptidase-4 inhibitors (DPP4i) + sodium-glucose cotransporter-2 inhibitors (SGLT2i) + metformin was better glycemic control, while 27% reported it as body weight reduction with a lower risk of hypoglycemia, and 25% reported that it offers end-organ protection to patients. As reported by 67% of the respondents, the advantages of vildagliptin + dapagliflozin + metformin over glimepiride + metformin + pioglitazone include better hemoglobin A1C (HbA1c) reduction, less weight gain, fewer hypoglycemia episodes, end-organ protection, and beta-cell preservation. Approximately 40% of clinicians observed a 1 to 1.5% HbA1c reduction with the use of vildagliptin + dapagliflozin + metformin therapy. Around 46% of clinicians reported a weight reduction of 2 to 3 kg following vildagliptin + dapagliflozin + metformin therapy. Approximately 50% of respondents noted that the incidence of glycemic variability with vildagliptin + dapagliflozin + metformin was rare.
Conclusion: The survey findings highlighted clinicians' preference for gliptin + SGLT2i + metformin as a triple-drug fixed oral antidiabetic combination therapy, noting significant advantages such as improved glycemic control, reduced hypoglycemia risk, and enhanced end-organ protection. Moreover, the survey noted the superior efficacy of vildagliptin + dapagliflozin + metformin over alternative combinations, demonstrating notable reductions in HbA1c levels, weight, and incidence of hypoglycemia, along with beta-cell preservation.