Date: {{$ActivityAssignDate}}

Dear Dr. {{ $doctorName }},

Subject: Evaluating the Significant Trends In CoMbinations of Anti-hyperglycemic Treatment AltErnatives in T2DM patients (ESTIMATE)

This report from the ICMR-INDIAB study highlights the enormous burden of non-communicable diseases faced by India. The number of patients with diabetes and prediabetes in India is 101 million and 136 million, respectively. The burden of diabetes is much higher than earlier reported figures. Type 2 diabetes mellitus (T2DM) is due to the progressive loss of β-cell insulin secretion frequently on the background of insulin resistance. Long term glycemic control plays a vital role in the prevention of complication of diabetes. Along with exercise and diet oral antidiabetic drugs play a key role in the control of glycemia in diabetic patients. This knowledge drives current clinical practice, in which treatment is directed to the attainment of near-normoglycaemia. The American Diabetes association standard of care guidelines 2024 recommends early combination therapy to be considered at treatment initiation to shorten the time to attain the individualised glycemic goals.

Metformin is the drug of the first choice for treating T2DM irrespective of age. Sulphonylureas have been extensively used for the treatment of type 2 diabetes and they lower blood glucose concentrations primarily by stimulating insulin secretion from the β cells of the pancreatic islets.4 Oral DPP4 inhibitors increase the availability of endogenous GLP1, thus enhancing glucose-induced insulin secretion and inhibiting glucagon release. These agents have no effect on gastric emptying and do not affect body weight. Sodium-glucose cotransporter 2 (SGLT2) is responsible for reabsorbing almost 90 % of the glucose filtered by the kidneys. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are an insulin-independent hypoglycemic agent that acts by blocking glucose reabsorption in the proximal tubule of the kidney, thus resulting in increased urinary excretion of glucose.

In the last few years combination agents have been released in the market for the management of diabetes. The combination agents have advantages like reduced cost, reduced pill burden and better compliance to therapy. In randomized controlled trial a triple drug fixed dose combination of Dapagliflozin + Sitagliptin + Metformin Extended Release tablets once daily has been shown to be significantly better in achieving glycemic control versus dual combination once daily in patients with type 2 diabetes poorly controlled with metformin. This was without any significant safety concerns.

The purpose of this survey is to understand the perceptions and practices in Diabetes management and to analyse the perception and prescription trends of sitagliptin combinations in recently diagnosed and uncontrolled patients of Type 2 Diabetes Mellitus (T2DM).

If you agree to participate, you will need to provide assessment response, on to the standard questionnaire form. A link will be provided for the same on your registered email address.

We trust you and we are partners in safe and effective drug therapy. In that spirit we hope you will consent to participate in this survey.

If you agree to participate in the said study, we would request you to sign and return the enclosed reply along with your visiting card for accuracy of records.