Rational Use of Dapagliflozin 5 mg: Real-World Prescribing Trends and a Practical ABCDEF Framework for Therapy Personalization

Abstract Objective: This study aims to bridge the existing gap by synthesizing clinical literature and real-world clinician perspectives to propose a practical, person-specific framework for the rational use of dapagliflozin 5 mg in India. Materials and Methods: A nationwide cross-sectional survey involving 423 Indian clinicians was conducted to evaluate real-world prescribing behaviors, rationale for 5 mg dosing, and patient selection patterns. Qualitative thematic analysis of open-ended responses was integrated with pharmacokinetic and clinical trial data to develop the ABCDEF framework—an evidence-informed, context-sensitive decision-support tool. Results: Of the respondents, 82.6% reported prescribing dapagliflozin 5 mg, typically for 5–20% of their type 2 diabetes mellitus patients. Key reasons included improved tolerability, reduced incidence of genitourinary infections and hypoglycemia, and suitability for lean, elderly, frail individuals and those with chronic kidney disease or polypharmacy. Evidence from dose-ranging trials shows that dapagliflozin 5 mg delivers glycemic efficacy close to that of the 10 mg dose, achieving over 80% of its HbA1c-lowering effect, with a potentially better tolerability profile in select patients. The ABCDEF framework—comprising age, body mass index, concerns, dysfunction, expected adverse events, and flexibility—was constructed to guide dose selection in real-world Indian practice. Conclusion: Dapagliflozin 5 mg represents a clinically meaningful and pragmatic option for individualized care in India. The ABCDEF framework integrates real-world experience with clinical evidence to support safer, contextually relevant prescribing. Future India-specific studies are essential to validate this approach and inform formal treatment guidelines.