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Evaluating the Significant Trends In CoMbinations of Anti-hyperglycemic Treatment Alternatives in T2DM patients

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ESTIMATE Survey

  1. In your daily practice, how many newly diagnosed patients of T2DM are seen? *

  2. In your daily practice, how many patients do you see on an average with uncontrolled T2DM? *

  3. In your daily practice, how many patients do you see on an average with uncontrolled T2DM and critical co-morbidities? *

  4. According to your clinical experience, do you feel that a newly diagnosed patient can be controlled only on Metformin? *

  5. Which are the commonest co-morbidities seen in a newly diagnosed T2DM patient of Indian origin? (Can select more than one) *

  6. In your opinion, which of these patient demographics are more related to developing of co-morbidities in a T2DM patient of India origin? (Can select more than one) *

  7. When do you prefer to use a combination of 2 drugs in the newly diagnosed T2DM patient? *

  8. Do you use any combination other than Sitagliptin and Metformin in your patients? *

  9. While prescribing the Sitagliptin and Metformin combination, do you find it more suitable/ beneficial for any particular age group? *

  10. When do you prefer to add the 3rd drug to the existing dual combination in your patients? *

  11. In your practice, which class of drug do you prefer to add to the Sitagliptin and Metformin combination therapy? *

  12. Do you prescribe Sitagliptin, Metformin and Glimepiride combination in your patients? *

  13. If the answer to Q12 is YES which type of patients you prefer to prescribe this combination?

  14. In your daily practice, how many of your patients are receiving Sitagliptin, Metformin and Glimepiride FDC? *

  15. Is there any time duration where you achieve the desirable outcomes in your patients on this combination? *

  16. Do you feel that the risk of hypoglycemic events is lower with FDC of these drugs? *

  17. Do you see any reduction in the dose when a FDC of these drugs is used? *

  18. Do you concur that Sitagliptin when added to the existing therapy may neutralize the weight gain after-effect of Glimepiride in your patients? *

  19. In your clinical practice, do you prescribe Sitagliptin, Metformin and Dapagliflozin FDC in your patients? *

  20. How many %age of your patients receives the Sitagliptin, Metformin and Dapagliflozin FDC? *

  21. Which co-morbidity is a priority while prescribing Sitagliptin, Metformin and Dapagliflozin FDC? (Can select more than one) *

  22. What parameter(s) is most important to you, while choosing to use Sitagliptin, Glimepiride and Metformin FDC? (Can select more than one) *

  23. What parameter(s) is most important to you, while choosing to use Sitagliptin, Metformin and Dapagliflozin FDC? *

  24. Do you feel that every T2DM patient with co-morbidity can be prescribed Sitagliptin, Metformin and Dapagliflozin FDC? *

  25. Which parameter influences your choice for a OHA combination in your uncontrolled T2DM patients? (Can select more than one) *

  26. Do you see any gender specificity while prescribing Sitagliptin, Metformin and Dapagliflozin FDC? *

  27. Are you aware that Sitagliptin and Dapagliflozin both target 8 out 8 components of the Ominous Octet of T2DM pathophysiology? *

  28. Do you think that this targeted action of Sitagliptin and Dapagliflozin combination is one of the key actions leading to benefits beyond just the glycemic control in your patients? *

  29. Evidence suggests that Sitagliptin shows equivalent action to a Sulphonylurea action. Do you think that a SU can be replaced in a prescription for a vulnerable patient? *

  30. As per your clinical experience, which are the key unmet medical needs in patients with type 2 diabetes mellitus with multiple cardiovascular risk factors? (Can select more than one). *

  31. Which are the key mechanisms of action of a DPP4 inhibitor? (Can select more than one?) *

  32. Which are the key mechanisms of action of a SGLT2 inhibitor? (Can select more than one?) *

  33. It is evidenced that SGLT2i reduces hospitalization for heart failure (HHF) and secondary renal outcomes in terms of incident or worsening nephropathy in patients with T2DM and CV disease. Do you see these benefits in your clinical practice? *

  34. It is anticipated that a combination of DPP-4 inhibitor and SU may synergistically stimulate insulin secretion and effectively reduce the dose of SU in your patients. Do you agree with this evidence? *

  35. The American Association of Clinical Endocrinologists and The American College of Endocrinology (AACE/ACE) 2019 guidelines advise for double drug treatment as a first- line approach in patients with ≥7.5% HbA1c. Do you follow this recommendation in your clinical practice? *

  36. If the answer is a YES for Q35, do you see clinical benefits in your patient through the early, aggressive combination therapy?

  37. In a newly found T2DM patient with high HbA1c [≥7.0 % (53 mmol/mol) to≤9.5 % (80 mmol/mol)], which combination would you prefer to prescribe? *

  38. In your practice, which is the more prominent clinical benefit observed with Metformin, Sitagliptin and Dapagliflozin FDC? *

  39. Does the probable increased risk of GTI/GUTI perceived with Sitagliptin, Metformin and Dapagliflozin FDC, acts as a limiting factor for prescribing in female patients? *

  40. Clinical evidence suggests that addition of DPP4i to SGLT2i lowers the risk of Genitourinary tract Infections by up to 26%. Do you see this benefit in your practice? *

  41. Do you perceive that the synergistic actions of Dapagliflozin and Sitagliptin in T2DM patients with renal impairment leads to slower progression of renal disease? *

  42. Do you believe durable control is an important parameter to consider along with efficacy, especially in recently diagnosed T2DM patients? *

  43. A Phase 3 clinical study in Indian patients has shown a significant reduction in HbA1c levels by 1.75% when prescribed Sitagliptin, Metformin and Dapagliflozin FDC. In your opinion, can this FDC be used to replace Insulin in some patients? *

  44. Do you prescribe either Sitagliptin, Metformin and Dapagliflozin FDC OR Sitagliptin, Metformin and Glimepiride FDC in combination with Insulin? *

  45. Have you observed any of these benefits in continued usage of these FDCs? (Can select multiple) *

  46. In your clinical practice, do you alternate the therapy in your patients, after a particular time duration? *

  47. If the answer to Q46 is a YES, what is an average duration of time for a continual treatment?

  48. How do you perceive the safety and tolerability of Dapagliflozin? *

  49. Do you advise your patients of any specific precautionary measures when prescribed Dapagliflozin? *

  50. Have you observed any response change/reduction in your patients on a long- term prescription of either Sitagliptin, Glimepiride and Metformin FDC OR Sitagliptin, Metformin and Dapagliflozin? *

  51. Is there any uncontrolled T2DM patient profile, where either of Sitagliptin, Glimepiride and Metformin FDC OR Sitagliptin, Metformin and Dapagliflozin?
    FDCs are contraindicated?     *

  52. In a typical Indian patient with high visceral obesity and BMI, which FDC is better suited for improved glycemic control, in your opinion? *

  53. As per the VERFIY trial, conventional approach of adding drugs in T2DM seems to be an inferior strategy as compared to therapy initiation with combination of drugs. Do you agree with this approach? *

  54. If the answer to Q53 is YES, please specify if you observe a better glycemic and other beneficial outcome with the dual/ triple combination approach?

  55. What is the single-most benefit that you observe when initiating your patient on a FDC at the start of the therapy? *

  56. Triple FDC of DAPA SITA MET ER tablets once daily was significantly better in achieving glycemic control versus dual combination once daily in patients with type 2 diabetes poorly controlled with metformin without any significant safety concerns. Does your clinical experience validate this statement? *

  57. Do you prefer prescribing FDCs in your patients, as compared to individual drug prescriptions in your patients? *

  58. What benefits do you observe in your patients, when prescribed an FDC? *

  59. With the new class of OHA drugs available, does this affect the affordability parameter in your T2DM patients? *

  60. What key points should be highlighted in the promotion of ISTAMET for managing uncontrolled T2DM patients? (Subjective question) *
  61. Is the representation of the clinical information clear on the marketing aid of ISTAMET D? *

  62. Do you feel that the Phase 3 Clinical Study conducted in Indian patients evaluating the benefits of ISTAMET-G (Metformin, Sitagliptin and Glimepiride FDC) gives useful insights? *