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

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 HbA 1C >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 HbA 1C >7.5%; Statement 2. Patients with HbA 1C >7.5% may be initiated with dual therapy of dipeptidyl peptidase-4 inhibitors (DPP4Is) + Metformin; and Statement 3. In Indian patients with HbA 1C >7.5% at diagnosis, DPP4Is + Metformin may be considered as a first-line therapy. Literature review revealed that HbA 1C 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 HbA 1C >7.5%. DPP4Is + Metformin is the preferred cost-effective option and may be considered as a first-line therapy in Indian T2DM patients with HbA 1C >7.5% at diagnosis.

Real-world observational study to capture demographic details of newly diagnosed type 2 diabetes mellitus

“…20 These findings are in agreement with the ICMR recommendations of routine screening of diabetes in India at 30 years more so in overweight and obese adults. 21 Our study reported a higher prevalence (53.11%) of T2DM in obese or overweight population, which is in concordance with the WHO data, wherein overweight and obesity accounted for 44% of the diabetes cases and the prevalence of obesity-related diabetes is expected to double to 300 million by 2025. [22][23][24] Highlighting this fact has led to the connotation 'diabesity'.…”

“…Also, American Association of Clinical Endocrinology 2018 consensus statement algorithm recommends metformin plus another agent in patients with HbA1c >7.5% at diagnosis. 21 Metformin and DPP-4 inhibitors were the preferred antidiabetic agents in the newly diagnosed T2DM patients as well as patients with microvascular complications. In this study, at time of diagnosis, 9.2% patients presented with microvascular complications.…”