Experts' perspective on the prescription of dapagliflozin for treating T2DM patients in Indian settings

Objective: To gather expert opinions on the clinical use and prescription practices of dapagliflozin for managing type 2 diabetes mellitus (T2DM) in Indian settings. Methodology: This cross-sectional study was conducted using a 23-item, multiple-response questionnaire to collect insights from specialists experienced in managing T2DM in routine clinical practice in India. The study included questions on current prescription practices, clinical observations, preferences, and experiences related to dapagliflozin use in T2DM treatment. Descriptive statistics were used to analyze the data, and categorical variables were presented as percentages to provide a clear understanding of their distribution. Results: This study included 446 clinicians, of whom 47% reported dapagliflozin as the most commonly used SGLT2 inhibitor, while 45% favored empagliflozin. A majority (53.51%) preferred dapagliflozin as an add-on to DPP4 inhibitors to achieve targeted glycemic control. Among the participants, 58% stated that their decision to prescribe dapagliflozin for heart failure with preserved ejection fraction (HFpEF) or reduced ejection fraction (HFrEF) was based on the patient's profile. Regarding glycemic control, 52% observed an HbA1c reduction of 1 to 1.5% after three months of treatment with SGLT2 inhibitors. Approximately 42% of respondents highlighted the pleiotropic benefits of SGLT2 inhibitors, including reductions in cardiovascular death and heart failure hospitalization, improved glycemic control with weight loss, and a lower risk of kidney disease progression and cardiovascular events. In terms of blood pressure management, 64% of clinicians reported a systolic blood pressure reduction of 5 to 10 mmHg with dapagliflozin 10 mg. Nearly 52% of participants preferred the fixed-dose combination of dapagliflozin and linagliptin for various patient groups, including elderly individuals, diabetics with obesity and cardiac complications, and those with obesity and renal complications. Conclusion: This study highlights dapagliflozin as a widely preferred treatment for T2DM management in India, offering benefits in glycemic control, cardiovascular and renal health, and blood pressure reduction. The preference for its combination with linagliptin further underscores its clinical utility.