Tiwaskar Mangesh, Hwu Chii-Min, Lim Marcelo, Bhandary Apeksha, Chang Iris
Shilpa Medical Research Centre, Mumbai, India.
Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan.
Diabetes Ther. 2025 Jul 21. doi: 10.1007/s13300-025-01770-3.
Type 2 diabetes mellitus (T2DM) is a global health concern with significant mortality rate associated with comorbidities like diabetic kidney disease (DKD) and cardiovascular disease (CVD). Thus, treatment guidelines recommend first-line treatment with sodium-glucose cotransporter 2 inhibitors (SGLT2Is) and/or glucagon-like peptide 1 (GLP-1) agonists for T2DM with comorbidities. However, in patients when these treatments are not tolerated, contraindicated, or considered expensive, dipeptidyl peptidase 4 inhibitors (DPP4Is) serve as an add-on or alternative for glycemic control without hypoglycemia risk. This study aimed to understand patients' preferences in three South Asian countries between SGLT2I (medication A) and DPP4I (medication B) and the reasons influencing their preference for effective management of T2DM.
In this cross-sectional study (November 2021 to November 2022) across India, Taiwan, and the Philippines, patients with T2DM on both SGLT2I and DPP4I or neither completed the survey to identify their medication preferences. Differences in baseline characteristics and preferred medication (chi-squared/Fisher's exact tests) and potential attributes influencing preferences (logistic regression) were analyzed.
Among 1224 participants, SGLT2I (64.5%) was significantly preferred over DPP4I (35.5%). Mean age of participants was 59.3 years and the majority were female patients/individuals (52.5%), overweight/obese (56.6%), with glycated hemoglobin levels ≥ 7% (57.6%). Common comorbidities included hypertension (62.7%) and dyslipidemia (75.5%); the majority were without history of CVD (83.7%) or CKD (84%). The most prescribed T2DM medication was biguanide (83.9%), followed by combination of SGLT2Is and DPP4Is (51.3%). The most influential attributes were blood sugar reduction (56.9%), reduced heart failure hospitalization (14.4%), and kidney disease risk reduction (12.1%). SGLT2I users showed a higher preference for heart failure hospitalization reduction (16.5%) or weight reduction (11.1%). Country of residence, thiazolidinedione use, and SGLT2I/DPP4I use were significant factors in logistic regression analyses.
Asian patients with T2DM preferred medication profile resembling SGLT2Is over DPP4Is. Understanding patient preferences may aid optimal glycemic control while reducing cardiovascular and renal risks.
2型糖尿病（T2DM）是一个全球性的健康问题，其死亡率与糖尿病肾病（DKD）和心血管疾病（CVD）等合并症密切相关。因此，治疗指南推荐将钠-葡萄糖协同转运蛋白2抑制剂（SGLT2Is）和/或胰高血糖素样肽1（GLP-1）激动剂作为伴有合并症的T2DM的一线治疗药物。然而，对于那些不能耐受、禁忌使用或认为费用昂贵的患者，二肽基肽酶4抑制剂（DPP4Is）可作为血糖控制的附加治疗或替代治疗，且无低血糖风险。本研究旨在了解三个南亚国家的患者在SGLT2I（药物A）和DPP4I（药物B）之间的偏好，以及影响他们对T2DM有效管理的偏好的原因。
在这项于2021年11月至2022年11月期间在印度、泰国和菲律宾开展的横断面研究中，正在使用SGLT2I和DPP4I或两者均未使用的T2DM患者完成了该调查，以确定他们对药物的偏好。分析了基线特征和首选药物（卡方检验/费舍尔精确检验）以及影响偏好的潜在因素（逻辑回归）的差异。
在1224名参与者中，SGLT2I（64.5%）比DPP4I（35.5%）更受青睐。参与者的平均年龄为59.3岁，大多数为女性患者/个体（52.5%），超重/肥胖（56.6%），糖化血红蛋白水平≥7%（57.6%）。常见的合并症包括高血压（62.7%）和血脂异常（75.5%）；大多数人没有CVD（83.7%）或CKD（84%）病史。最常用的T2DM药物是双胍类（83.9%），其次是SGLT2Is和DPP4Is的联合使用（51.3%）。最具影响力的因素是血糖降低（56.9%）、心力衰竭住院率降低（14.4%）和肾病风险降低（12.1%）。SGLT2I使用者对心力衰竭住院率降低（16.5%）或体重减轻（11.1%）表现出更高的偏好。居住国家、噻唑烷二酮类药物的使用以及SGLT2I/DPP4I的使用是逻辑回归分析中的显著因素。
亚洲T2DM患者更喜欢类似SGLT2Is的药物治疗方案而非DPP4Is。了解患者偏好可能有助于实现最佳血糖控制，同时降低心血管和肾脏风险。
