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Review
. 2021 Dec;10(12):4398-4409.
doi: 10.4103/jfmpc.jfmpc_2378_20. Epub 2021 Dec 27.

Optimizing the treatment of newly diagnosed type 2 diabetes mellitus with combination of dipeptidyl peptidase-4 inhibitors and metformin: An expert opinion

Ashok K Das  1 , Pramod Gandhi  2 , Banshi Saboo  3 , Sanjay Reddy  4 , Rajeev Chawla  5 , Abdul Hamid Zargar  6 , Rajiv Kovil  7 , Manoj Chawla  8 , S K Sharma  9 , Sunil Gupta  10 , B M Makkar  11 , Vinod Mittal  12 , Soumik Goswami  13 , S R Arvind  14 , Shalini Jaggi  15 , Sarita Bajaj  16 , Sambit Das  17
Affiliations
Review

Optimizing the treatment of newly diagnosed type 2 diabetes mellitus with combination of dipeptidyl peptidase-4 inhibitors and metformin: An expert opinion

Ashok K Das et al. J Family Med Prim Care. 2021 Dec.

Abstract

The expanding burden of Type 2 Diabetes Mellitus (T2DM) in today's world, with respect to incidence, prevalence, and cost incurred, is an existential risk to society. Various guidelines recommend individualization of treatment. This expert opinion aims to review the recent evidences and reach a consensus on the preferable combination therapy for use in newly diagnosed Indian T2DM patients with HbA1C >7.5%. The core committee included seventeen diabetes specialists. Three statements were developed, discussed, and rated by specialists and recommendations were noted. Specialists were requested to rate the statements using a 9-point Likert's scale with score of 1 being "Strongly Disagree" and 9 being "Strongly Agree". Statement-specific scores of all the specialists were added and mean score of ≥7.00 was considered to have achieved a consensus. Statements used to meet the consensus were: Statement 1. Majority of newly-diagnosed Indian diabetics have HbA1C >7.5%; Statement 2. Patients with HbA1C >7.5% may be initiated with dual therapy of dipeptidyl peptidase-4 inhibitors (DPP4Is) + Metformin; and Statement 3. In Indian patients with HbA1C >7.5% at diagnosis, DPP4Is + Metformin may be considered as a first-line therapy. Literature review revealed that HbA1C level at the time of diagnosis in majority of Indian T2DM patients is >7.5%. Consensus was reached that dual anti-diabetic therapy should be initiated in patients with HbA1C >7.5%. DPP4Is + Metformin is the preferred cost-effective option and may be considered as a first-line therapy in Indian T2DM patients with HbA1C >7.5% at diagnosis.

Keywords: Combination therapy; DPP4 inhibitors; HbA1C; Metformin; T2DM.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Glycemic Control Algorithm by AACE/ACE 2018 (Adapted from AACE/ACE 2018)[6]
Figure 2
Figure 2
Glycemic Control Algorithm by ADA/EASD 2018 (Adapted from ADA/EASD 2018)[1]
Figure 3
Figure 3
Research Society for the Study of Diabetes in India (RSSDI's) Patient-centric approach or ABCD (EFGH) approach for diabetes management representing therapy (Adapted from RSSDI 2018)[7]
See this image and copyright information in PMC

References

    1. Davies MJ, D’Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American diabetes association (ADA) and the European association for the study of diabetes (EASD) Diabetes Care. 2018;41:2669–701. - PMC - PubMed
    1. International Diabetes Federation. Diabetes Atlas. 7th ed. Brussels, Belgium: International Diabetes Federation; 2015.
    1. India State-Level Disease Burden Initiative Diabetes Collaborators. The increasing burden of diabetes and variations among the states of India: The Global Burden of disease study 1990-2016. Lancet Glob Health. 2018;6:e1352–62. - PMC - PubMed
    1. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. American diabetes association (ADA);European association for the study of diabetes (EASD). Management of hyperglycemia in type 2 diabetes: A patient-centered approach: Position statement of the American diabetes association (ADA) and the European association for the study of diabetes (EASD) Diabetes Care. 2012;35:1364–79. - PMC - PubMed
    1. Anjana RM, Deepa M, Pradeepa R, Mahanta J, Narain K, Das HK, et al. Prevalence of diabetes and prediabetes in 15 states of India: Results from the ICMR–INDIAB population-based cross-sectional study. Lancet Diabetes Endocrinol. 2017;5:585–96. - PubMed