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. 2022 May;13(5):1097-1114.
doi: 10.1007/s13300-022-01219-x. Epub 2022 Mar 25.

Expert Opinion: Optimum Clinical Approach to Combination-Use of SGLT2i + DPP4i in the Indian Diabetes Setting

Manoj Chadha  1 , Ashok Kumar Das  2 , Prasun Deb  3 , Kalyan Kumar Gangopadhyay  4 , Shashank Joshi  5 , Jothydev Kesavadev  6 , Rajiv Kovil  7 , Surender Kumar  8 , Anoop Misra  9 , Viswanathan Mohan  10
Affiliations

Expert Opinion: Optimum Clinical Approach to Combination-Use of SGLT2i + DPP4i in the Indian Diabetes Setting

Manoj Chadha et al. Diabetes Ther. 2022 May.

Abstract

The Asian-Indian phenotype of type 2 diabetes mellitus is uniquely characterized for cardio-metabolic risk. In the context of implementing patient-centric holistic cardio-metabolic risk management as a priority, the choice of various combinations of antidiabetic agents should be individualized. Combined therapy with two classes of antidiabetic agents, namely, dipeptidyl peptidase 4 inhibitors and sodium-glucose co-transporter-2 inhibitors, target several pathophysiological pathways. The wide-ranging clinical outcomes associated with this combination, including improvement of glycemia and adiposity, reduction of metabolic and vascular risk, safety, and simplicity for sustainable compliance, are extremely relevant to the Asian Indian patient population living with T2DM. In this review we describe the available evidence in detail and present a rational practical guidance for the optimum clinical use of this combination in this patient population.

Keywords: Asian Indian phenotype; Cardio-metabolic risk; Dipeptidyl peptidase-4 inhibitor; Fixed-dose combinations; Sodium-glucose cotransporter-2 inhibitor; Type 2 diabetes.

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Figures

Fig. 1
Fig. 1
The “ominous octet” of type 2 diabetes mellitus and the target sites for glucose-lowering therapies. DDP-4i Dipeptidyl peptidase-4 inhibitor, GLP-1RA glucagon-like peptide-1 receptor agonist, SGLT2i sodium-glucose co-transporter-2 inhibitors. (Adapted from Chatterjee and Davies [9])
Fig. 2
Fig. 2
Illustration of the complementary glucose-lowering activities of DPP4i and SGLT2i in type 2 diabetes mellitus. GIP Glucose-dependent insulinotropic polypeptide, SBP systolic blood pressure. (Adapted from Scheen [13])
Fig. 3
Fig. 3
Incidence of genitourinary tract infections favors the use of the SGLT2i + DPP4i fixed-drug combination. CI Confidence interval, GTI genitourinary tract infection, RR relative risk. (Adapted from Fadini et al. [52])
Fig. 4
Fig. 4
a Guidance for initiation of SGLT2-i + DPP4-i FDC based on glycemic factors. b Guidance for appropriate use of SGLT2-i + DPP4-i FDC based on glycaemic control. c Guidance for initiation of SGLT2-i + DPP4-i FDC based on CV risk. d Guidance for initiation of SGLT2-i + DPP4-i FDC based on CKD risk. e Guidance for initiation of SGLT2-i + DPP4-i FDC based on promoting weight loss or preventing hypoglycemia. CKD Chronic kidney disease, CV cardiovascular, CVOT cardiovascular outcome trial, FDC fixed-dose combination, HbA1c glycated hemoglobin, HF heart failure, Met metformin, T2DM type 2 diabetes mellitus
Fig. 4
Fig. 4
a Guidance for initiation of SGLT2-i + DPP4-i FDC based on glycemic factors. b Guidance for appropriate use of SGLT2-i + DPP4-i FDC based on glycaemic control. c Guidance for initiation of SGLT2-i + DPP4-i FDC based on CV risk. d Guidance for initiation of SGLT2-i + DPP4-i FDC based on CKD risk. e Guidance for initiation of SGLT2-i + DPP4-i FDC based on promoting weight loss or preventing hypoglycemia. CKD Chronic kidney disease, CV cardiovascular, CVOT cardiovascular outcome trial, FDC fixed-dose combination, HbA1c glycated hemoglobin, HF heart failure, Met metformin, T2DM type 2 diabetes mellitus
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