Alkem

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MESIDA2

A study to evaluate clinical effectiveness and safety of FDC of Metformin, Sitagliptin and Dapagliflozin in Indian T2DM patients in real world practice

BASIC DETAILS

Patient code (Do not write name here) *

Date *

Diagnosis (Type 2 diabetes Mellitus)

Patient's Age (Years)*

Gender*

Male Female

Height (cm) *

Weight (kg) *

Risk factors

Obesity (BMI) *

Underweight (<18.5 kg/m²) Normal BMI (18.5-22.9 kg/m²) Overweight (23.0 -24.9 kg/m²) Obese (≥25 kg/m²)

Active Smoker *

Yes No

Alcohol intake *

Yes No

Tobacco use *

Yes No

Family history of diabetes *

Yes No

Physical inactivity *

Yes No

Complication at the time of diagnosis *

Neuropathy Nephropathy Stroke CAD Retinopathy Any Other

Clinical examination *

Systolic BP (mm Hg)

Diastolic BP (mm Hg)

History of usage of drugs *

Metformin SU AGI Pioglitazone DPP4i SGLT-2i Insulin/Insulin Analogues GLP 1 receptor agonists

Drug now prescribed *

Dapagliflozin (10mg) + Metformin (500mg) + Sitagliptin (100mg) Dapagliflozin (5mg) + Metformin (500mg) + Sitagliptin (50mg)

Key reason to choose this FDC (tick as applicable) *

High baseline HbA1c Cardiovascular benefit Excellent efficacy Good safety profile Less weight gain Insulin resistance improvement

Investigations *

	Baseline	Post 3 months treatment
HbA1c
FPG (mg/dl)
PPG (mg/dl)
Body weight (kg)
BP (mm hg)

Other parameters

Clinician's Global Assessment of safety (Tick Appropriate) *

Excellent Good Fair Poor

Clinician's Global Assessment of Effectiveness (Tick Appropriate) *

Excellent Good Fair Poor

Safety profile

Have you observed any other adverse drug reactions with usage of FDC *

Yes No

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