Dapagliflozin-Saxagliptin Combination - The Quest for Optimal Glycemic Control With Cardio-Renal Protection in Type 2 Diabetes Mellitus: An Expert Consensus in Indian Settings

Sujoy Ghosh, Subhash K. Wangnoo, Sachin Chittawar, Suresh Damodharan, Yogesh Kadam, Pramila Kalra, K.P. Suresh Kumar, I. Periyandavar, S.K. Sharma, Abdul Hamid Zargar

Abstract


The combination of dapagliflozin (DAPA; a sodium-glucose cotransporter-2 inhibitor (SGLT2i)) and saxagliptin (SAXA; a dipeptidyl peptidase-4 inhibitor (DPP4i)) added on to metformin targets multiple pathophysiological pathways and provides a synergistic effect on glycemic control. Notably, both DAPA and SAXA have demonstrated cardiovascular safety and shown to slow the progression of declining renal function in patients with type 2 diabetes mellitus (T2DM) having comorbid cardiovascular or renal diseases. Together, DAPA + SAXA has an acceptable tolerability profile, comparable with the individual agents and with a low propensity for hypoglycemia. The addition of DAPA + SAXA to metformin has been associated with low frequency of urinary tract and genital infections, attributed to the complementary effects of combining an SGLT2i and a DPP4i. This review compiles insights from a group of leading experts from India, summarizing concise clinical practice recommendations for the use of a fixed-dose combination of DAPA (10 mg) + SAXA (5 mg) in Indian patients with T2DM. The review encompasses available evidence and clinical experiences, highlighting the benefits of this combination for comprehensive glycemic control and enhanced cardio-renal protection in the management of T2DM.




J Endocrinol Metab. 2024;14(3):128-148
doi: https://doi.org/10.14740/jem946

Keywords


Dipeptidyl peptidase-4 inhibitor; Cardiovascular comorbidities; Chronic kidney disease; Fixed-dose combination; Sodium-glucose cotransporter-2 inhibitor; Type 2 diabetes mellitus

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