# Indian Clinicians’ Perspectives on Utilizing Dapagliflozin-Based Combination Therapy for the Management of Obesity in Patients With Type 2 Diabetes Mellitus

## TL;DR

This study explores Indian clinicians' views on using dapagliflozin+metformin to manage obesity in type 2 diabetes patients, highlighting its benefits and challenges.

## Contribution

The study provides insights into Indian clinicians' preferences and barriers for dapagliflozin-based therapies in managing obesity and T2DM.

## Key findings

- Most clinicians prioritize weight management and glycemic control in T2DM patients.
- Dapagliflozin+metformin FDCs are the preferred initial treatment for overweight/obese T2DM patients.
- Noncompliance and pill burden are major barriers to effective obesity management.

## Abstract

Background: In India, abdominal obesity is highly prevalent among both men and women and is associated with an increased risk of developing type 2 diabetes mellitus (T2DM). This presents a dual challenge for Indian clinicians in simultaneously managing body weight and glycemic levels. This article aimed to understand Indian clinicians' perspectives regarding obesity and T2DM association and utilization of dapagliflozin+metformin combination therapy for obesity management in patients with T2DM.

Methods: A cross-sectional online survey was conducted with 914 Indian clinicians, including endocrinologists, diabetologists, consultants, and general physicians. A structured questionnaire was used to evaluate clinicians' knowledge of the role of obesity in T2DM, their attitudes toward weight management, and current practices in addressing obesity in patients with T2DM. The survey also assessed clinicians' utilization of pharmacological and nonpharmacological interventions, and their perceptions of barriers to effective obesity management. Data from the questionnaires were analyzed using Statistical Package for the Social Sciences version 29.0 (IBM Corp., Armonk, NY). Descriptive and inferential statistics were also calculated. Statistical significance was set at p< 0.05.

Results: Of the 914 clinicians, 910 (99.50%) agreed that weight management and glycemic control in T2DM patients are the primary treatment goals. Cardiovascular disease and hypertension were identified as the most recognized complications of obesity in T2DM patients by 742 (81.80%) and 682 (74.61%) clinicians, respectively. Dapagliflozin+metformin fixed-dose combinations (FDCs) were the preferred initial glucose-lowering combination for overweight/obese T2DM patients by 624 (68.28%) clinicians, followed by dapagliflozin+sitagliptin FDCs by 390 (42.68%) clinicians. Glycemic control, weight loss, and cardiovascular and renal benefits are critical considerations for clinicians. A majority of 670 (73.30%) clinicians reported noncompliance, followed by 570 (62.36%) who reported pill burden as a significant barrier to managing obesity in patients with T2DM.

Conclusion: Most Indian clinicians recognize the importance of obesity management in patients with T2DM. However, patient noncompliance and pill burden were identified as significant barriers to managing obesity in these patients. There is a preference for dapagliflozin+metformin FDCs in the management of overweight T2DM patients. Thus, prescribing FDCs in routine clinical practice and ensuring patient access could improve the outcomes in this high-risk group.