908-P: Use of DPP4i/SGLT2i Fixed Dose Combinations in Indian Clinical Practice—A KAP Survey

Introduction & Objective: The Asian-Indian phenotype presents with increased insulin resistance, reduced Beta-Cell function, abdominal adiposity & clustering of CV risk factors. In India generic DPP4i/SGLT2i Fixed Drug Combinations (FDCs) are prescribed to enhance compliance amongst patients with T2DM. We aimed to study attitude & practice of Indian Physicians pertaining to patient populations benefitting from these FDCs.

Methods: We designed and utilized a 6-question survey during an Indian Medical Congress. Convenience Sampling was used to reach out to at least n=150 physicians. Descriptive Statistics was used to analyze data using MS-Excel 2019.

Results: Amongst 185 surveyed physicians, 48% respondents (n=89) reported over 40% of newly-diagnosed, treatment-naïve patients presenting with baseline HbA1c >8%. 52% (n=97) had more than 40% patients with HbA1c >8.5% despite Metformin monotherapy. Considering glycemic control in 3 clinical scenarios, 66% (n=122) physicians preferred DPP4i/SGLT2i FDCs for all scenarios namely (a) patients uncontrolled on Metformin monotherapy with HbA1c >8.5% (b) treatment-naive patients with contraindication/intolerance to Metformin & HbA1c >8% (c) add-on to insulin. Also 60.5% (n=112) physicians favored DPP4i/SGLT2i FDC for all 4 given reasons i.e. CV benefits, lower hypoglycemia risk, weight loss promotion & targeting multiple pathophysiological pathways. 85% (n=158) reported reduced Genito-Urinary Tract Infections (GUTI) with concurrent administration of DPP4i with SGLT2i or FDC. Most favored FDC was Sitagliptin/Dapagliflozin (36%, n=67).

Conclusion: In India there is significant burden of patients with T2DM who present with high HbA1c (newly diagnosed or despite metformin monotherapy). Generic DPP4i/SGLT2i FDCs are preferred in these patients also considering their extra-glycemic benefits. Most physicians (85%) noted reduction in SGLT2i associated GUTIs with use of DPP4i/SGLT2i FDCs. Further studies may validate these findings.