Clinician Perspectives on SGLT2 Inhibitor Use in Type 2 Diabetes and Heart Failure: Findings from an Indian Cross-sectional Survey

Abstract

Background: Type 2 diabetes mellitus (T2DM) and heart failure (HF) frequently coexist, sharing common risk factors and contributing to increased morbidity, mortality, and healthcare burden worldwide. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), particularly dapagliflozin, have emerged as important therapeutic agents by providing glycemic control along with proven cardiovascular and renal benefits in patients with T2DM and comorbid HF. Aim: The present study assesses clinicians’ treatment preferences and their perceptions regarding the glycemic, cardiovascular, and renal benefits of SGLT2 inhibitors, especially dapagliflozin and its fixed-dose combinations, in the management of patients with T2DM and comorbid heart failure. Objective: To assess clinicians' perspectives on the treatment preferences, and perceived glycemic benefits of sodium–glucose cotransporter-2 inhibitors (SGLT2i), particularly dapagliflozin and their fixed-dose combinations (FDC) in the management of patients with type 2 diabetes mellitus (T2DM) and comorbid heart failure (HF). Methods: This cross-sectional survey was conducted across India and used a 22-item multiple-response questionnaire booklet named “DELIGHT study” to assess treatment preferences and glycemic benefits of SGLT2i, focusing on dapagliflozin and FDCs. Descriptive statistics were used to summarize responses, and no inferential testing was conducted. Result: Among 366 clinicians included, nearly half (47.54%) reported that 21–30% of their patients with diabetes had coexisting HF in routine practice. About 52% indicated that the majority of patients with HF were classified as NYHA class II, followed by NYHA class III (25.14%). Over half of clinicians (55.19%) stated that 26–40% of patients required the addition of SGLT2i each month to achieve glycemic targets. The majority (96.72%) of clinicians identified dapagliflozin as the most frequently used SGLT2i for the management of T2DM with HF in clinical practice. Most (68.31%) respondents observed a 5–10 mmHg reduction in systolic blood pressure with dapagliflozin 10 mg in routine care. About 57% reported perceiving all pleiotropic benefits of SGLT2i beyond glycemic control, including cardiovascular and renal effects.  As indicated by 72% of participants, the most commonly prescribed combination is dapagliflozin + sitagliptin. Approximately two-thirds (66.12%) of clinicians preferred the FDC of dapagliflozin + linagliptin across all listed clinical scenarios, including in elderly patients and those with obesity and cardiac or renal complications. Conclusion: The survey highlights SGLT2i, predominantly dapagliflozin, as being widely used in patients with diabetes and HF, demonstrating meaningful glycemic, blood pressure, and cardio-renal benefits. FDCs are commonly preferred across diverse clinical scenarios, supporting integrated, patient-centered management in routine practice. However, the findings are based on clinicians’ perceptions and descriptive analyses and should be interpreted accordingly.