Triple drug therapy for optimal glycemic control in patients with T2DM in COVID-19 times: Indian clinician perspective

Introduction: Background: Optimum glycemic control is pivotal to prevent complications and premature mortality, and improve quality of life in patients with type 2 diabetes mellitus (T2DM) Patients uncontrolled on mono- or dual- antidiabetic therapy require triple drug therapy (TDT) to achieve optimal glycemic control Objectives: Objective: This survey was carried out to understand the clinical utilization of TDT in attaining durable glycemic control in patients with T2DM Methods: Methods: A structured objective questionnaire was used for the survey and responses were sought from 270 Healthcare practitioners (HCPs) across India during May 15 to May 30, 2020 via Google forms The questionnaire consisted of questions related to proportion of patients with uncontrolled glycemia, role and choice of TDT in achieving durable glycemic control, importance of cost of therapy, etc The responses were analyzed descriptively Results: Results: The respondent HCP pool comprised consulting physicians (47%), diabetologists (30%), endocrinologists (16%), and family physicians (7%) More than 45% of HCPs agreed that 30-50% of their diabetes patients have HbA1c >8 5%, and uncontrolled fasting and postprandial blood glucose levels while 21% mentioned such uncontrolled glycemia in more than 50% of their patients Approx 52% of the HCPs think that 50-70% of their patients can be brought under control with TDT, while a quarter of HCPs believe that more than 70% of their patients can be effectively managed with TDT 72% of respondents aligned in their views that the cost of anti-diabetic therapy is an important parameter during Covid-19 pandemic In uncontrolled T2DM patients taking a combination of modern sulphonylurea and metformin, HCPs rated DPP-4 inhibitor, pioglitazone and voglibose as third line options for achieving durable glycemic control 60% of the HCPs opined that triple drug therapy can delay the initiation of insulin therapy in patients with T2DM Almost two-thirds of the HCPs agreed that double and triple fixed dose OAD combinations have better pharmacy availability than insulin, enabling better patient accessibility Conclusion: Conclusion: A high proportion of patients have a suboptimal glycemic control during covid-19 pandemic, and TDT can control a majority of these patients The survey also highlights the HCPs' opinion that the triple drug therapy has multiple patient-centric benefits like cost effectiveness, accessibility, delaying insulin usage