# Empagliflozin Perception Mapping Survey

## TL;DR

This survey explores how Indian doctors perceive and prescribe empagliflozin, an SGLT2 inhibitor, for type 2 diabetes patients with heart and kidney issues.

## Contribution

The study provides real-world insights into physician perceptions and prescribing practices of empagliflozin in India.

## Key findings

- Most physicians recognize heart failure as underdiagnosed in T2DM and use empagliflozin for patients with cardiovascular and renal comorbidities.
- Cost, guideline awareness, and therapeutic inertia remain barriers to optimal empagliflozin use.
- Prescribing trends reflect recent evidence supporting empagliflozin in both HFrEF and HFpEF.

## Abstract

Background: Heart failure (HF) is a frequent yet often underdiagnosed comorbidity among individuals with type 2 diabetes mellitus (T2DM). Sodium-glucose cotransporter-2 (SGLT2) inhibitors, particularly empagliflozin, are known to provide significant cardiovascular and renal benefits and are endorsed by international guidelines. However, real-world gaps in adoption persist, influenced by diagnostic challenges, cost considerations, and clinician familiarity. This survey assessed physician perceptions and prescribing practices regarding empagliflozin across diverse T2DM patient profiles in India.

Methods: A cross-sectional, questionnaire-based survey was conducted using a voluntary convenience sampling approach among physicians from various specialities managing T2DM. As the study involved anonymized physician responses without patient-level data, ethical approval was not applicable. The survey captured information on demographic characteristics, heart failure risk assessment, SGLT2 inhibitor prescribing patterns, perceived cardio-renal benefits, and perceived barriers. Data were analyzed descriptively and summarized as frequencies and proportions.

Results: Most respondents acknowledged that HF remains underdiagnosed in T2DM and recognized the role of empagliflozin in patients with cardiovascular and renal comorbidities. Physicians reported frequent use of empagliflozin in T2DM with multiple cardiovascular risk factors, established atherosclerotic cardiovascular disease (ASCVD), and chronic kidney disease (CKD). Recent evidence supporting its benefit in both, heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) was reflected in prescribing trends. Cost, guideline awareness, and therapeutic inertia were cited as continuing barriers to optimal utilization.

Conclusions: Indian physicians demonstrate strong awareness and largely guideline-concordant prescribing attitudes toward empagliflozin in T2DM with cardiovascular or renal complications. Nevertheless, under-recognition of asymptomatic HF and variability in CKD management highlight the need for targeted education and policy initiatives to further strengthen evidence-based practice.