Clinicians’ preferences and perspectives on the management of type 2 diabetes mellitus in Indian settings

Objective: To gather clinicians' preferences and perspectives on managing type 2 diabetes mellitus (T2DM) in Indian settings, with a focus on combination therapies, prescription patterns, factors affecting glycemic control, and treatment adherence strategies.

Methodology: This cross-sectional study utilized a multiple-response questionnaire consisting of 23 questions on feedback, clinical observations, prescription practices, and experiences of specialists in managing T2DM in routine settings.  Data analysis was performed using descriptive statistics.

Results: The study included 442 clinicians, with 52% of respondents reporting that aggressive weight reduction and lifestyle modifications are the most common management approaches for young patients (<45 years) with HbA1c >7%. According to 30% of clinicians, lack of awareness is a key factor contributing to poor glycemic control in patients with T2DM. Approximately 77% reported that vildagliptin is the most frequently preferred gliptin for young T2DM patients (<45 years). As noted by 72% of clinicians, the combination of vildagliptin + dapagliflozin is the most commonly chosen DPP4 inhibitor used alongside dapagliflozin. Regarding the use of a fixed-dose single-pill combination of vildagliptin + dapagliflozin, 48% of respondents reported prescribing it to 11–25% of their patients. Around 36% of participants stated that this combination is particularly favored for T2DM patients with comorbid atherosclerotic cardiovascular disease (ASCVD). The majority (93.67%) of clinicians identified voglibose as the preferred drug for patients with high postprandial blood glucose (PPBG). Approximately 61% preferred adding voglibose to glimepiride + metformin in cases of high PPBG, uncontrolled HbA1c on dual therapy, or poor lifestyle adherence.

Conclusion: This study indicates a preference for a combination-based, patient-centric approach to T2DM management, with vildagliptin and dapagliflozin emerging as key therapeutic choices among clinicians. Enhancing patient awareness and adherence remains a critical challenge. It also highlights the need for targeted interventions to improve glycemic control and optimize treatment strategies in Indian settings.