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

Aim: To gather clinicians’ perspectives regarding the prescription practice of the fixed-dose combinations (FDC) of sitagliptin + metformin and the triple drug combination of voglibose + glimepiride + metformin for managing type 2 diabetes mellitus (T2DM) in Indian settings.
Methodology: The cross-sectional multiple-response questionnaire-based survey was conducted among experts from various states across India. The questionnaire, comprising 25 questions, addressed feedback, clinical observations, and experience in managing T2DM using FDCs. Descriptive statistics was used for data analysis, presenting categorical variables as percentages. Graphs were created using Microsoft Excel 2013.
Results: The survey included 879 clinicians from diverse clinical settings in India. Approximately 38% reported a monthly incidence of new-onset diabetes as 25-30, with 55-60% of patients failing to achieve the HbA1c goal of ≤7%. Sedentary lifestyles, poor dietary habits, and family history were cited as major contributors to early-onset diabetes (84%). Regarding sitagliptin + metformin therapy, 28% of clinicians reported >40% of patients achieving the target HbA1c goal (≤7%) over 4 years. Approximately 61% of clinicians regarded this combination as ideal for newly diagnosed T2DM patients with HbA1c >7.5%. Nearly 56% of the respondents observed a reduction of 1-1.5% in HbA1c with this combination therapy, highlighting the advantages such as HbA1c control, absence of hypoglycemia and weight gain, and cardio protective effects. In real-world clinical settings, the FDC of voglibose, glimepiride, and metformin demonstrated a 1.5%-1.8% reduction in HbA1c, as reported by 45% of clinicians. Adherence rates of 60%-70% were observed for this FDC, and it was recommended for the duration of one year (39%) and 6-8 months (33%).
Conclusion: Sitagliptin-metformin combination was preferred due to multitude of benefits including superior HbA1c control, absence of hypoglycemia and weight gain, along with enhanced cardiac safety. The triple-drug combination of voglibose, glimepiride, and metformin was also highly effective in reducing HbA1c levels, demonstrating greater adherence and robust efficacy.