Expert opinion on the preferences and practices of sitagliptin in type 2 diabetes management in Indian settings

Abstract

Objective: To gather expert opinion regarding the use of sitagliptin and its combinations in type 2 diabetes mellitus (T2DM) in Indian settings. Methodology: This cross-sectional study utilized a 23-item, multiple-response questionnaire to gather expert opinions from clinicians with expertise in managing diabetes. The questionnaire covered drug class preferences, particularly DPP-4 inhibitors and sulfonylureas, along with factors influencing clinical decisions. Descriptive statistics were used to analyze the data, and categorical variables were presented as percentages to illustrate response distributions. Results: The study enrolled 394 experts, with the majority (87.56%) preferring sitagliptin as their DPP-4 inhibitor of choice in routine practice. Over half (56.6%) of the clinicians favored sitagliptin due to its cardiovascular benefits, tolerability in non-alcoholic fatty liver disease (NAFLD) patients, lipid profile improvement, weight neutrality, and suitability across all stages of T2DM. Approximately 30% reported glycemic variability as the primary reason for prescribing sulfonylureas alongside sitagliptin. Half of the clinicians preferred gliclazide as an add-on with sitagliptin and metformin, while 48.22% favored the gliclazide-sitagliptin combination for elderly T2DM patients. Gliclazide 60 mg MR was the preferred add-on with sitagliptin and metformin for 65.74% of clinicians. The newer single-pill combination of sitagliptin + glimepiride + metformin was used in 11-20% of patients by around 58% of clinicians, while 40% reported using the sitagliptin + pioglitazone + metformin combination in their practice. Conclusion: This study highlights clinicians' preference for sitagliptin in T2DM management, emphasizing its efficacy, safety, and tolerability. The choice of gliclazide MR for elderly patients and the increasing use of single-pill combinations reflect a shift toward personalized treatments.