Das Ashok K, Gandhi Pramod, Saboo Banshi, Reddy Sanjay, Chawla Rajeev, Zargar Abdul Hamid, Kovil Rajiv, Chawla Manoj, Sharma S K, Gupta Sunil, Makkar B M, Mittal Vinod, Goswami Soumik, Arvind S R, Jaggi Shalini, Bajaj Sarita, Das Sambit
Professor and Head of Endocrinology, Pondicherry Institute of Medical Sciences, Pondicherry, India.
Department of Endocrinology, Gandhi Research Institute, Nagpur, Maharashtra, India.
J Family Med Prim Care. 2021 Dec;10(12):4398-4409. doi: 10.4103/jfmpc.jfmpc_2378_20. Epub 2021 Dec 27.
The expanding burden of Type 2 Diabetes Mellitus (T2DM) in today's world, with respect to incidence, prevalence, and cost incurred, is an existential risk to society. Various guidelines recommend individualization of treatment. This expert opinion aims to review the recent evidences and reach a consensus on the preferable combination therapy for use in newly diagnosed Indian T2DM patients with HbA >7.5%. The core committee included seventeen diabetes specialists. Three statements were developed, discussed, and rated by specialists and recommendations were noted. Specialists were requested to rate the statements using a 9-point Likert's scale with score of 1 being "Strongly Disagree" and 9 being "Strongly Agree". Statement-specific scores of all the specialists were added and mean score of ≥7.00 was considered to have achieved a consensus. Statements used to meet the consensus were: Statement 1. Majority of newly-diagnosed Indian diabetics have HbA >7.5%; Statement 2. Patients with HbA >7.5% may be initiated with dual therapy of dipeptidyl peptidase-4 inhibitors (DPP4Is) + Metformin; and Statement 3. In Indian patients with HbA >7.5% at diagnosis, DPP4Is + Metformin may be considered as a first-line therapy. Literature review revealed that HbA level at the time of diagnosis in majority of Indian T2DM patients is >7.5%. Consensus was reached that dual anti-diabetic therapy should be initiated in patients with HbA >7.5%. DPP4Is + Metformin is the preferred cost-effective option and may be considered as a first-line therapy in Indian T2DM patients with HbA >7.5% at diagnosis.
在当今世界，2型糖尿病（T2DM）在发病率、患病率和所产生的成本方面负担不断加重，这对社会构成了生存风险。各种指南都建议治疗个体化。本专家意见旨在回顾近期证据，并就用于新诊断的糖化血红蛋白（HbA）>7.5%的印度T2DM患者的优选联合治疗达成共识。核心委员会包括17名糖尿病专家。制定了三项声明，由专家进行讨论和评分，并记录了相关建议。要求专家使用9点李克特量表对声明进行评分，1分为“强烈不同意”，9分为“强烈同意”。将所有专家针对特定声明的分数相加，平均分≥7.00被视为达成共识。用于达成共识的声明如下：声明1.大多数新诊断的印度糖尿病患者的HbA>7.5%；声明2. HbA>7.5%的患者可起始二肽基肽酶-4抑制剂（DPP4Is）+二甲双胍的双重治疗；声明3.对于诊断时HbA>7.5%的印度患者，DPP4Is+二甲双胍可被视为一线治疗。文献综述显示，大多数印度T2DM患者诊断时的HbA水平>7.5%。已达成共识，HbA>7.5%的患者应起始双重抗糖尿病治疗。DPP4Is+二甲双胍是首选的性价比高的选择，对于诊断时HbA>7.5%的印度T2DM患者可被视为一线治疗。
