Understanding the Preference of a Dipeptidyl Peptidase-4 Inhibitor and its Combination Therapy in Type 2 Diabetes Mellitus among Indian Clinicians

Abstract Background: Multiple dipeptidyl peptidase-4 inhibitors (DPP4is) are available in India. The class of DPP4i presents as a heterogeneous group with differences among the molecules. Thus, there is a need to evaluate the choice of DPP4i and its combinations among Indian clinicians. This survey aims to assess the choice of DPP4i and its combinations among Indian clinicians in the management of patients with type 2 diabetes mellitus (T2DM). Methodology: This was a cross-sectional questionnaire-based survey of clinicians in India conducted between December 2022 and March 2023. Data were analyzed and expressed using descriptive statistics. Results: Among the 1033 clinicians in the survey, the majority (71.73%) were in the age group of 31–50 years, 66.6% had a postgraduate degree in medicine, and 74.93% had a private consulting practice. Almost half of the participants opined that the response of DPP4i is similar in T2DM patients irrespective of age (47.24%) and body mass index (46.95%). Among the various DPP4i available in India, sitagliptin was opined to provide greater glycated hemoglobin reduction (72.80%), faster reduction in blood glucose (71.25%), and greater improvement in glycemic variability (73.28%) by the majority of the clinicians. Most clinicians opined sitagliptin as the preferred DPP4i in T2DM patients irrespective of age and in various comorbidities. Around 65.25% of clinicians opined that sitagliptin was associated with fewer adverse events in patients with T2DM. In terms of combination therapy, the majority of the clinicians opined sitagliptin/dapagliflozin was most preferred in T2DM patients (81.51%: In T2DM with atherosclerotic cardiovascular disease, 79.28%: In T2DM with heart failure, 53.63%: In T2DM with chronic kidney disease) among the various DPP4i/sodium–glucose cotransporter 2 inhibitors (SGLT2i) available in India. Conclusions: The survey conducted among over 1000 clinicians across India is suggestive of sitagliptin and sitagliptin/dapagliflozin being the preferred DPP4i and DPP4i/SGLT2i, respectively, among Indian clinicians for the management of a wide range of patients with T2DM.