Endocrine Abstracts

Background: Despite global guidelines recommending initiation of SGLT2i drugs like dapagliflozin in type 2 diabetes (T2DM) patients with cardiovascular (CV) or renal risk, its clinical translation is still lacking in India.

Objective: To understand clinicians’ perspectives regarding the association of CV risk and T2DM in Indian patients, and the need for the use of combination therapies with dapagliflozin in T2DM patients, in Indian clinical practice.

Methods: A cross-sectional, questionnaire-based survey involving 873 diabetologists and consulting clinicians was conducted. The survey questionnaire consisted of 30 questions that accessed T2DM patient profiles and clinicians’ preference for treatment approach, dapagliflozin use for cardiorenal protection and its combination therapy.

Results: In routine clinical practice, 73% of clinicians observed more than 20 T2DM patients weekly. The majority of these patients (91%) were aged between 40 – 60y. The clinicians observed that these patients presented with varying comorbid conditions like obesity (39%), coronary artery disease (38%) and chronic kidney disease (14%). 37% of clinicians said CV risk was observed in 50 – 80% of T2DM patients. In the treatment of T2DM patients, 44% of clinicians preferred SGLT2i, followed by DPP4i (31%) and SU (28%) as the first choice of antidiabetic class of drug other than metformin. Among the SGLT2i class, dapagliflozin (91%) was the most preferred choice. According to 55% of clinicians, the most prominent clinical benefit of dapagliflozin was a reduction in HF hospitalisation and 69% suggested dapagliflozin to be the most effective SGLT2i in patients with renal impairment. Around 94% of clinicians agreed that early initiation and aggressive intensification of combination therapy should be done and 58% preferred SGLT2i-based combinations. In the case of SGLT2i + DPP4i fixed-dose combinations (FDC) for T2DM patients with CV or renal risk, 79% of clinicians preferred dapagliflozin based FDC (66%: dapagliflozin+ sitagliptin and 13%: dapagliflozin + vildagliptin). In comparison, 76% strongly recommended the FDC for a triple combination of dapagliflozin + sitagliptin + metformin. All the clinicians agreed that SGLT2i drugs like dapagliflozin must be initiated in T2DM patients with comorbidities, and 98% opined that SGLT2i like dapagliflozin is one drug across HF spectrum among T2DM patients. However, 89% of clinicians were concerned with dapagliflozin underutilisation in Indian patients.

Conclusion: The findings from the survey highlight the clinical benefits of dapagliflozin and its FDCs in T2DM patients with CV/renal risk. Early initiation and aggressive intensification with dapagliflozin FDCs in T2DM patients is highly recommended.