Published: 2017-03-28

Management of type 2 diabetes mellitus: insights into prescribing trends

Prasanna Kumar K. M., Shahu Ingole, Tushar Tamboli, Rishi Jain


Background: Recently, management of type 2 diabetes mellitus (T2DM) has changed with advent of novel agents like DPP4i, SGLT2i and GLP-1 agonist. Of these, DPP4i have emerged as promising agents as monotherapy and as an add-on to metformin for improved glycaemic control.  This survey was planned to explore current prescribing trends of physicians of India for the management of T2DM.

Methods: This was a prospective, cross sectional, questionnaire-based survey of physicians and endocrinologist across different geographic areas in India. A survey questionnaire consisting of 10 questions related to management of T2DM in real-world clinical settings was prepared, validated in a small group of physicians and then administered to physicians and endocrinologists.

Results: Responses from 502 physicians were received. About 60% physicians prefer DPP4i as first add-on to metformin followed by sulfonylurea (SU) (30%). Amongst DPP4i, vildagliptin and sitagliptin were preferred by 48% and 28% physicians respectively as first add-on to metformin. For patients uncontrolled on metformin + SU therapy, 54 % physicians prefer DPP4i as second add-on. Vildagliptin is perceived to have the better efficacy and safety data, as suggested by 40% and 43% physicians respectively. Large number of physicians (48%) were hesitant to prescribe teneligliptin due to insufficient data. SGLT2 inhibitors are preferred as third add-on by 44% physicians.

Conclusions: DPP4i are being increasingly preferred by physician as an add-on to metformin. Among DPP4i, the survey revealed that vildagliptin is the most preferred DPP4i as an add-on to metformin possibly owing to its established safety and efficacy data.


DPP4 inhibitors, Type 2 diabetes mellitus, Vildagliptin

Full Text:



Ji LN, Pan CY, Lu JM, Li H, Li Q, Li QF, et al. Efficacy and safety of combination therapy with vildagliptin and metformin versus metformin up-titration in Chinese patients with type 2 diabetes mellitus: study design and rationale of the vision study. Cardiovasc Diabetol. 2013;2:118.

Li CJ, Liu XJ, Bai L, Yu Q, Zhang QM, Yu P, et al. Efficacy and safety of vildagliptin, Saxagliptin or sitagliptin as add-on therapy in Chinese patients with type 2 diabetes inadequately controlled with dual combination of traditional oral hypoglycemic agents. Diabetol Metab Syndr. 2014;6:69.

Cefalu WT. American Diabetes Association Standards of Medical Care in Diabetes 2016. J Clin Applied Res Edu. 2016;39(1):1-111.

Tang YZ, Wang G, Jiang ZH, Yan TT, Chen YJ, Yang M, et al. Efficacy and safety of vildagliptin, sitagliptin, and linagliptin as add‑on therapy in Chinese patients with T2DM inadequately controlled with dual combination of insulin and traditional oral hypoglycemic agent. Diabetol Metab Syndr. 2015;7:91.

Mathieu C, Barnett AH, Brath H, Conget I, De Castro JJ, Goke R, et al. Effectiveness and tolerability of second-line therapy with vildagliptin vs. other oral agents in type 2 diabetes: A real-life worldwide observational study (EDGE). Int J Clin Pract. 2013;67(10):947-56.

Cornell S. Type 2 diabetes treatment recommendations update: appropriate use of DPP4 inhibitors. J Diabetes Metab. 2014;5:8.

Odawara M, Hamada I, Suzuki M. Efficacy and safety of vildagliptin as add-on to metformin in Japanese patients with type 2 diabetes mellitus. Diabetes Ther. 2014;5:169-180.

Trujillo MJ, Nuffer W, Ellis SL. GLP-1 receptor agonists: a review of head to-head clinical studies. Ther Adv Endocrinol Metab. 2015;6(1):19-28.

Gupta V, Kalra S. Choosing a Gliptin. Indian J Endocrinol Metab. 2011;15(4):298-308.

Ahre´n B, Foley JE, Bosi E. Clinical evidence and mechanistic basis for vildagliptin’s action when added to metformin. Diabetes Obes Metab. 2011;13:193-203.

Mishriky BH, Cummings DM, Tanenberg RJ. The efficacy and safety of DPP4 inhibitors compared to sulfonylureas as add-on therapy to metformin in patients with type 2 diabetes: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2015;109(2):378-88.

Iwamoto Y, Kashiwagi A, Yamada N, Terao S, Mimori N, Suzuki M, et al. Efficacy and safety of vildagliptin and voglibose in Japanese patients with type 2 diabetes: a 12-week, randomized, double-blind, active-controlled study. Dia Obes Metab. 2010;12(8):700-8.

Odawara M, Suzuki M, Hamada I, Iguchi A. Clinical evaluations of the vildagliptin combination therapy in type 2 diabetes patients- A long term safety study of 52 weeks treatment with vildagliptin as add-on therapy with metformin, TZD, a-GI or Glinides. J New Rem Clin. 2012;12:2593-611.

Guerci B, Monnier L, Serusclat P, Petit C, Valensi P, Huet D, et al. Continuous glucose profiles with vildagliptin versus sitagliptin in add-on to metformin: Results from the randomized Optima study. Dia Metab. 2012;38:359-66.

Blüher M, Kurz I, Dannenmaier S, Dworak M. Efficacy and safety of vildagliptin in clinical practice-results of the PROVIL-study. World J Diabetes. 2012;3(9):161-9.

González-Ortiz M, Guerrero-Romero JF, Violante-Ortiz R, Wacher-Rodarte N, Martínez-Abundis E, Aguilar-Salinas C, et al. Efficacy of glimepiride/metformin combination versus glibenclamide/metformin in patients with uncontrolled type 2 diabetes mellitus. J Diabetes Complications. 2009;23(6):376-9.

Holstein A, Plaschke A, Egberts EH. Lower incidence of severe hypoglycaemia in patients with type 2 diabetes treated with glimepiride versus glibenclamide. Diabetes Metab Res Rev. 2001;17(6):467-73.

Martin S, Beuth HKJ, Van Leendert R, Schneider B, Scherbaum WA. Change in patients’ body weight after 12 months of treatment with glimepiride or glibenclamide in Type 2 diabetes: a multicentre retrolective cohort study. Diabetologica. 2003;46(12):1611-7.

Kalra S. Emerging role of Dipeptidyl Peptidase-4 Inhibitor Vildagliptin in the management of Type 2 DM. JAPI. 2011;59:237-45.

Russo E, Penno G, Prato SD. Managing diabetic patients with moderate or severe renal impairment using DPP-4 inhibitors: focus on vildagliptin. Diabetes Metab Syndr Obes. 2013;6:161-70.

Lukashevich V, Prato DS, Araga M, Kothny W. Efficacy and safety of vildagliptin in patients with type 2 diabetes mellitus inadequately controlled with dual combination of metformin and sulphonylurea. Diabetes Obes Metab. 2014;16(5):403-9.

Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339:229-34.

Juutilainen A, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Type 2 diabetes as a “coronary heart disease equivalent”: an 18-year prospective population-based study in Finnish subjects. Dia Care. 2005;28:2901-7.

Schramm TK, Gislason GH, Kober L, Rasmussen S, Rasmussen JN. Diabetes patients requiring glucose-lowering therapy and nondiabetics with a prior myocardial infarction carry the same cardiovascular risk: a population study of 3.3 million people. Circulation. 2008;117:1945-54.

McInnes G, Evans M, Del Prato S, Stumvoll M, Schweizer A, Lukashevich V, Shao Q, Kothny W. Cardiovascular and heart failure safety profile of vildagliptin: a meta-analysis of 17 000 patients. Diabetes Obes Metab. 2015;17(11):1085-92.

Scirica BM, Bhatt DL, Braunwald E, Steg PG, Davidson J, Hirshberg B, et al. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med. 2013;369:1317-26.

Hocher B, Reichetzeder C, Alter ML. Renal and cardiac effects of DPP4 inhibitors-from preclinical development to clinical research. Kidney Blood Press Res. 2012;36(1):65-84.

Karagiannis T, Bekiari E, Boura P, Tsapas A. Cardiovascular risk with DPP4 inhibitors: latest evidence and clinical implications. Ther Adv Drug Saf. 2016;7(2):36-8.

Schweizer A, Dejager S, Foley JE, Couturier A, Ligueros-Saylan M, Kothny W. Assessing the cardio–cerebrovascular safety of vildagliptin: meta-analysis of adjudicated events from a large phase III type 2 diabetes population. Diabetes Obes Metab. 2010;12(6):485-94.

Scheen AJ. SGLT2 inhibitors: benefit/risk balance. Curr Diab Rep. 2016;16(10):92.

Sharma SK, Panneerselvam A, Singh KP, Parmar G, Gadge P, Swami OC. Teneligliptin in management of type 2 diabetes mellitus. Diabetes Metab Syndr Obes. 2016;9:251-60.