# Optimizing Cardiovascular Outcomes in Type 2 Diabetes: Early Initiation of Dapagliflozin and Sitagliptin From a Cardiologist's Perspective

## TL;DR

This paper discusses how early use of a diabetes drug combination can help reduce heart disease risks in patients with type 2 diabetes.

## Contribution

The paper provides expert guidance on early initiation of dapagliflozin and sitagliptin for managing cardiovascular risks in type 2 diabetes.

## Key findings

- Early combination therapy with SGLT2i and DPP4i is emphasized for timely glycemic control in T2DM patients with CVD risks.
- Combining dapagliflozin and sitagliptin offers glycemic and extra-glycemic benefits by targeting multiple pathophysiological pathways.
- Expert insights support the use of FDC SGLT2i + DPP4i as a treatment choice for better patient outcomes in T2DM with CVD risk.

## Abstract

Introduction: Cardiovascular (CV) disease (CVD) risk is greater in patients with diabetes mellitus and is the major contributor to disability and premature mortality compared to those who do not have diabetes. The clinical implications of CVD in people with type 2 diabetes mellitus (T2DM) have increased the emphasis on concurrent treatment to prevent the onset of CVD through personalized management for glycemic control and CVD risk management.

Methods: Key opinion leaders, comprising 98 cardiologists from across India, participated in seven advisory board meetings held in various cities to explore the challenges and strategies for the early initiation of fixed-dose combinations (FDCs) of sodium-glucose co-transporter-2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP4i) with a focus on the combination of dapagliflozin and sitagliptin in addressing the CVD risks in patients with T2DM and high risk for CV complications. The expert group discussed the available literature evidence from the clinical trials, systematic reviews, and real-world studies on the benefits of FDC of SGLT2i and DPP4i and FDC of dapagliflozin and sitagliptin to provide rational and practical guidance for its optimal use in addressing the CVD risks in patients with T2DM.

Results: The expert group emphasized the importance of timely glycemic control and early initiation of combination therapy of FDC of SGLT2i + DPP4i in T2DM with CVD risks. Addressing multiple pathophysiological aspects of T2DM is crucial, and considering combination therapy with SGLT2i and DPP4i may be pertinent in this context. Combining dapagliflozin and sitagliptin in FDC to target multiple pathophysiological pathways for T2DM appears to have several glycemic and extra-glycemic benefits.

Conclusion: This practical guidance document provides valuable insights from leading cardiologists that would support clinicians in selecting the synergistic combination SGLT2i + DPP4i (dapagliflozin + sitagliptin) FDC as an appropriate treatment choice in early intensive therapy in managing people with T2DM and CVD risk for better patient outcomes. The expert opinion in this guidance builds on the established guideline recommendations on FDC of SGLT2i and DPP4i.