Expert perspectives on the use of combination therapies for glycemic control in newly diagnosed type 2 diabetes mellitus in Indian settings

Objective: To gather expert opinion on the perspectives and preferences regarding the prescription of various combinations used in the management of newly diagnosed and uncontrolled type 2 diabetes mellitus (T2DM) patients. Methodology: The cross-sectional survey utilized a 23-item, multiple-response questionnaire to gather expert opinion from specialists in managing diabetes. The survey encompassed questions about current prescription practices, clinical observations, preferences, and experiences using combination therapies in routine settings for T2DM management. Result: The survey involving 1007 experts revealed that 68% of clinicians preferred dual combination therapy when initiating pharmacotherapy for newly diagnosed T2DM patients with HbA1c levels >8%. Among oral antidiabetic drugs (OADs), dipeptidyl peptidase-4 inhibitors (DPP4i) are the most preferred class, favored by 40% of clinicians. For initial combination therapy, 53% preferred the DPP4i + metformin combination. Vildagliptin + metformin was considered highly efficacious by 54% of respondents and moderately efficacious by 42%. About 51% occasionally recommended a fixed-dose combination (FDC) of DPP4i + SGLT2i as initial therapy. Vildagliptin + dapagliflozin is the preferred choice for initial therapy, which 65% of clinicians prefer. Additionally, 62% favored vildagliptin + metformin as the first-line FDC. In obese T2DM patients, 48% preferred DPP4i + metformin for initiating pharmacotherapy. Conclusion: The survey findings show that clinicians favor DPP4i-based combination therapies for newly diagnosed T2DM patients, especially when HbA1c exceeds 8%. Vildagliptin + metformin is commonly preferred as first-line therapy and is considered highly or moderately effective. In obese patients, DPP4i + metformin is favored, while vildagliptin + dapagliflozin is preferred for initial treatment.