Clinicians’ Perspectives on Fixed-Dose Combinations and Triple Therapy in Type 2 Diabetes Mellitus: A Cross-Sectional Survey in India

Abstract

Objective: To assess clinicians’ perspectives on the use of fixed-dose combinations (FDCs) and triple therapy in type 2 diabetes mellitus (T2DM) in Indian settings, with a focus on therapeutic preferences and perceived clinical benefits. Methods: The cross-sectional survey was conducted between June 2024 and December 2024 among clinicians involved in T2DM management across India. Participants were recruited using a convenience sampling approach based on clinical experience. A 22-item structured questionnaire was used to collect data on treatment practices, preferences, and perceptions regarding FDCs and triple therapy. Descriptive statistical analysis was performed, and results are presented as frequencies (n) and percentages (%). Results: A total of 1,817 clinicians participated in the survey. Among them, 1,130 (62.19%) reported that FDCs play an important role in achieving glycemic control, while 1,410 (77.6%) believed that combination therapies improve affordability, adherence, and outcomes. Approximately 1,526 (84.0%) preferred adding a sodium glucose co-transporter 2 inhibitor (SGLT2i) to a dipeptidyl peptidase-4 inhibitor (DPP4i) and metformin regimen. The most commonly used triple therapy was metformin + DPP4i + SGLT2i, as reported by 1,254 (69.0%) respondents. Linagliptin was the preferred DPP4i for 1,315 (72.32%) clinicians. Additionally, 1,393 (76.66%) perceived that the dapagliflozin + linagliptin combination offers advantages over dapagliflozin + vildagliptin in terms of glycemic control and organ protection. However, responses reflect clinician perceptions and may be influenced by practice patterns and experience. Conclusion: The findings indicate a strong clinician preference for FDCs and triple therapy in T2DM management, particularly combinations involving metformin, DPP4i, and SGLT2i. While these therapies are perceived to improve glycemic control, adherence, and organ protection, the results are based on self-reported data and should be interpreted with consideration of potential biases and the observational nature of the study.