Expert consensus on triple combination of glimepiride, metformin, and voglibose usage in patients with type 2 diabetes mellitus in Indian settings

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a progressive disease affecting a huge chunk of the population globally. Aim: This study aimed to address the existing gaps in knowledge about the triple-drug combination and to provide guidance to the clinicians on the triple-drug combination in Indian settings. Materials and Methods: Doctors’ opinions (n = 2262) were recorded based on surveys and round table meetings. The National Expert Group approved a standard questionnaire that included 13 questions pertaining to T2DM management using a triple combination of glimepiride, metformin, and voglibose, which were prepared, discussed, and evaluated by the experts. After due discussions, the expert group analyzed the result and further recommendations were made and a consensus statement was derived. Results: Out of 2262, 1498 were consulting physicians, 358 were diabetologists, 93 were endocrinologists, 104 were cardiologists, and 209 were family physicians with focus on diabetes practice or had more than 10 years of experience from different regions from India. A strong consensus was observed for targeting postprandial hyperglycemia in the management of T2DM, which may reduce cardiovascular (CV) disease risk. The experts opined that meal pattern was the major factor affecting glycemic variability. The experts recommended early use of triple combination as it improves glycemic control (early aggressive control, beyond three oral drugs are on no benefit, ingrained). More than 90.0% of clinicians believed that this combination is cost-effective. Most agreed (32.0%) that this combination moderately reduces body weight. Additionally, it was felt that triple combination in patients with T2DM is also beneficial during Ramadan. Conclusion: In the present expert opinion-based consensus, most of the healthcare providers believed that triple-drug combination can potentially improve glycemic control and can delay/postpone the microvascular and CV complications. However, more multicentric studies are needed to support these recommendations.