Category: Diabetes/Prediabetes/Hypoglycemia

ADOPTING AN AFFORDABLE DDP IV INHIBITOR FOR EARLY ACCESS TO SGLT2 INHIBITORS TO ADDRESS PATHOPHYSIOLOGICAL DEFECTS – RESULTS FROM THE CONTINUITY CARE PROGRAM

Monday, Apr 8
1:00 AM – 2:00 AM

Objective :

Pharmacological therapy of T2DM is now increasingly complex. Patient centered approach with individualisation based on the triad of efficacy, risk-benefit ratio and affordability determines the continuity of diabetes care, especially in the pay from pocket-real world setting


Methods :

The patients from the continuity care program were managed based on guideline directed, cost effective, pathophysiological approach at advanced diabetes care centre. We evaluated the HbA1c of 1473 T2DM patients on customised, continuity care program during last three years (2016-2018), initiated after the availability of, non-patented, cost effective gliptin (teneligliptin) and patented SGLT2 inhibitors (SGLT2i). The patients were matched for the concomitant usage of teneligliptin and SGLT2i for atleast 6 months. t-test and ANOVA were used for the statistical analysis.


Results :

The mean HbA1c at the time of diagnosis recorded in 2016 (n=1473), repeated in 2017 (n=1125) and 2018 (n=888) was 9.2% (SD±1.7,95%CI 8.8-9.6), 8.8% (SD±1.8,95% CI 8.4-9.1) and 8.2 % (SD±1.9,95 % CI 7.8-8.4) (p<0.0001), respectively. The patients on concomitant teneligliptin and SGLT2i forlastthree years had lesser HbA1c (mean HbA1c 8.3%) as compared to the patients on the individual monotherapy of teneligliptin (mean HbA1c 8.9%) and SGLT2 inhibitor (mean HbA1c 8.5%)  (p<0.0001). The trends were numerically superior for the systolic BP reduction (-1.42 mmHg) (p=0.099) and statistically significant for the body weight reduction (-1.56 kg; p<0.0001). The no. of patients who had HbA1c monitoring were the highest in 2018 (n=597) which was almost equivalent to the cumulative HbA1c recordings in 2017 (n=306) and 2016 (n=292).


 


Discussion :

The adoption of an affordable evidence-based gliptin has contributed for the accessibility to the patented SGLT2i, targeting pathophysiological defects, resulting in a consistent reduction in HbA1c. Pharmacoeconomic friendly approach has translated to enhanced adoption of HbA1c estimation, continuity of care, reduction in weight and BP, even in patients with a higher baseline HbA1c at the time of diagnosis. 


Conclusion :

The long-term results from our single centre experience, strengthen our approach to deliver HbA1c reductions. The cost of the therapy is a critical element for adopting an enhanced pathophysiological approach enabling a better glycemic care and translate the results from the evidence-based medicine to the real-world experience.  


 

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Shalini Jaggi

Head
Dr V Mohan's Centre, Delhi

Senior Diabetologist

Shalini Jaggi

Head
Dr V Mohan's Centre, Delhi

North Delhi Diabetic Centre

Siddanth Trehan

Consultant
North Delhi Diabetes Centre

Consultant

Astha Chawla

Resident
SP Medical College Bikaner

Resident

Vinay Kumar

Consultant
North Delhi Diabetes Centre

Consultant