International Journal of Research in Medical Sciences

Kalra P et al. Int J Res Med Sci. 2024 Aug;12(8):xxx-xxx

www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012

DOI: https://dx.doi.org/10.18203/2320-6012.ijrms20241968
Original Research Article

Role of vildagliptin and its combination in type 2 diabetes mellitus

management: a knowledge, attitude, and practice survey among
Indian healthcare professionals
Pramila Kalra1, Mala Dharmalingam1,2, Samir Kubba3,4, Heena Bhojwani5, Sanjay Jain5*

1
Department of Endocrinology, M. S. Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
2
Department of Endocrinology, Bangalore Endocrinology and Diabetes Research Centre, Karnataka, India
3
Mohan Heart Care, Delhi, India
4
Dharamshila Narayana Superspeciality Hospital, Delhi, India
5
Department of Medical Services, Alembic Pharmaceuticals Ltd., Mumbai, Maharashtra, India

Received: 20 June 2024

Accepted: 11 July 2024

*Correspondence:
Dr. Sanjay Jain,
E-mail: sanjay.jain@alembic.co.in

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Type 2 diabetes mellitus (T2DM) is a prevalent condition, with a significant burden in India, affecting
approximately 74.2 million individuals. Vildagliptin, a selective dipeptidyl peptidase 4 (DPP-4) inhibitor, is approved
globally for monotherapy and combination therapy. Recently, it became available as a generic product, which increased
its accessibility to patients. This study aimed to assess the knowledge, attitude, and practice (KAP) regarding
vildagliptin and its combination in T2DM management.
Methods: A pan-India cross-sectional KAP survey was conducted from February 2022 to March 2023. The survey
utilized a specially designed questionnaire focusing on various aspects of vildagliptin treatment. A total of 1,440
healthcare professionals (HCPs) with recognized qualifications and experience in diabetes management participated.
Descriptive statistics were employed for data analysis.
Results: HCPs reported initiating Vildagliptin monotherapy at an HbA1c 6.5-7.5%, while combination therapy with
vildagliptin and metformin at HbA1c 7-8%. Vildagliptin was primarily preferred as an add-on to metformin. Inadequate
HbA1c control with existing therapy emerged as the primary trigger for switching to vildagliptin and metformin
combination. Treatment-naïve T2DM patients with HbA1c 1.5% above target and those uncontrolled on metformin
monotherapy or dual therapy were reported to benefit most from combination therapy. Combination therapy was
reported to result in a glycemic reduction of 1.0-1.5%. HCPs perceived vildagliptin better than other DPP4 inhibitors
due to its efficacy in reducing HbA1c and a lower risk of hypoglycemia.
Conclusions: The KAP survey highlights the value Indian HCPs place on the effectiveness and tolerability of
vildagliptin and their attitudes and practices in its use, highlighting its clinical utility in routine practice.

Keywords: Diabetes, KAP survey, Vildagliptin, Metformin, DPP4 inhibitors, India

INTRODUCTION Health Organization (WHO), non-communicable diseases

(NCDs) were responsible for 74% of global deaths in
Diabetes represents one of the most pressing global health 2019, with diabetes contributing to 1.6 million fatalities,
issues in the 21st century, standing among the top 10 causes making it the ninth leading cause of death worldwide.2
of mortality alongside cardiovascular disease (CVD), Projections indicate that by 2035, nearly 592 million
respiratory issues, and cancer.1,2 According to the World individuals may die due to diabetes.3

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Type 2 diabetes mellitus (T2DM), which accounts for 90% Knowledge, attitude, and practice (KAP) surveys evaluate
of all diabetes cases, significantly impacts individuals the beliefs and perceptions of a population on a specific
across various age groups and regions.4 Moreover, it has topic and how they implement it.13 The objective of the
attained epidemic proportions in several developing present study was to assess the knowledge, attitude, and
economies like China and India.4,5 In India, approximately practice of Indian healthcare professionals (HCPs) towards
74.2 million individuals are affected by diabetes. In other the use of vildagliptin in routine clinical practice, which
terms, India accounts for 1 in 7 of all adults living with refers to situations in real-life scenarios or day-to-day
diabetes worldwide.6 outpatient department (OPD) clinics, ruling out
standardized regulations of a clinical trial.
In response to food intake, the gut releases incretin
hormones like glucagon-like peptide 1 (GLP-1) and METHODS
glucose-dependent insulinotropic peptide, which stimulate
insulin secretion in a glucose-dependent manner, inhibit Survey design and setting
glucagon secretion, and slow gastric emptying. However,
these hormones are deactivated by dipeptidyl peptidase-4 This was a cross-sectional, descriptive, observational
(DPP-4).7,8 The impaired incretin effect observed in questionnaire-based KAP survey across India from
patients with T2DM led to the development of incretin- February 2022 to March 2023. The flow of the study was:
based treatments, including DPP-4 inhibitors and GLP-1 sharing the questionnaire with participants i.e., HCPs who
receptor agonists, which respectively inhibit DPP-4 gave consent, followed by filling of the questionnaire
activity and resist breakdown by DPP-4.7 based on experience and clinical use in the past, collection
of questionnaires, compilation, analysis, and presentation
Vildagliptin is a selective and reversible inhibitor of DPP- of data.
4.8 It is approved in more than 110 countries globally as
monotherapy and combination therapy for T2DM. Survey participants
Additionally, there is a fixed-dose combination of
vildagliptin/metformin that is also available.7 Survey participants were registered medical practitioners,
including diabetologists, endocrinologists, cardiologists,
Vildagliptin increases the functioning of beta cells by physicians, and nephrologists with recognized
improving insulin secretion rate, and alpha-cell function qualifications, working in OPDs of privately run
by restoring glucose-related glucagon suppression.8-10 clinics/hospitals in a tertiary care setting and using
Long-term therapy can delay beta-cell deterioration in vildagliptin and vildagliptin-metformin combination.
T2DM.9 It exhibits synergism with metformin, leading to
increased active GLP-1 levels, which contributes to long- Survey instrument
term improvements in beta-cell activity. Vildagliptin
treatment improves peripheral insulin sensitivity and The questionnaire was a specially designed, self-
postprandial triglyceride-rich lipoprotein metabolism.8,9 completion, and structured questionnaire, which included
12 multiple-choice questions. Questions were related to
Vildagliptin can be used as monotherapy in metformin- the knowledge, attitude, and practice in the use of
intolerant patients, for treatment intensification in patients vildagliptin and vildagliptin-metformin combination
with inadequately controlled T2DM, as a part of dual or among healthcare professionals. These included 4
triple combination therapy, in patients with co-morbidities knowledge, 6 attitude, and 2 practice-based questions.
like cardiovascular disease, in obese patients, and patients Since the survey was voluntary, respondents were not
who want to avoid weight gain. Furthermore, its obligated to answer every question. Additionally,
acceptance by physicians suggests the wide use of participants were free to select more than one response to
vildagliptin for each subgroup of the diabetic continuum in a question if they deemed it appropriate or desirable.
Indian settings.11
Knowledge-based questions were as follows: level of
Vildagliptin is commonly prescribed in Indian T2DM HbA1c for initiating monotherapy and combination
patients because it reduces the mean amplitude of therapy, advantages of vildagliptin over other DPP4
glycemic excursion, has a lower risk of hypoglycemia, and inhibitors, and preferred class of drugs added to
is weight-neutral.10 Recently, the vildagliptin patent vildagliptin.
expired, resulting in the introduction of generic versions,
making it more accessible to patients for regular use.12 Attitude-based questions were as follows: patient profiles
that would benefit from vildagliptin monotherapy and
Given the existing evidence and the place in therapy of combination therapy with metformin, factors responsible
Vildagliptin and its combination in T2DM management, it for switching to vildagliptin from other treatments, factors
is crucial to understand its use, attitude towards its responsible for switching to vildagliptin and metformin
initiation, treatment intensification, and the patient groups from vildagliptin, a preferred class of drug in patients
that benefit in the clinical practice. uncontrolled on metformin and sulfonylurea, and potential
to replace other drugs.

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Practice-based questions were as follows: most-prescribed Table 1: Knowledge among HCPs about vildagliptin.
vildagliptin dose and percent reduction in glycemic
parameters. S. Percentage
Questions
no. of HCPs
Ethical considerations At what level of HbA1c do you initiate only
monotherapy of vildagliptin?
This was a survey through which no patient-related data 6.5 to 7.5 50
was captured and therefore ethics committee approval was 1
>7.5 to 8.5 46
not necessary and hence not obtained. As this was not a >8.5 to 9.5 4
clinical trial, no clinical trial registration was required. 7-8 0
Which HbA1c range would you consider to start
Data analysis vildagliptin and metformin for a newly detected
T2DM patient?
Descriptive statistics were used to summarize the 7 to 8 79
2
qualitative data by number and percentage for each
>8 to 9 18
category in each question. Many participants responded to
more than one option for some questions if desired and >9 to 10 0
suitable. The denominator for calculating the proportion 7.5 to 8.5 7
for a particular question was the total number of In your opinion how is vildagliptin better than
participants who replied to a particular question. Data has 3 other DPP-4 inhibitors e.g. sitagliptin and
been summarized and presented in tables and graphs. teneligliptin?
Better HbA1c reduction 64
RESULTS Less chance of hypoglycemia 50
Cost of therapy 39
A total of 1, 440 healthcare professionals participated in More inhibition of DPP4 enzyme 14
this survey across India and all completed the survey. Less chance of secondary failure 0
Others 0
Knowledge about vildagliptin and its combination DPP4: Dipeptidyl peptidase 4, HbA1c: glycated hemoglobin;
T2DM: type 2 diabetes mellitus
Half of the participants reported initiating monotherapy of
vildagliptin at an HbA1c of 6.5-7%. Another significant
proportion reported initiating monotherapy of vildagliptin
at an HbA1c of 7.5-8.5% (Table 1). Furthermore, the
majority of participants reported that would prefer
initiating vildagliptin and metformin combination at an
HbA1c level of 7-8% in newly detected T2DM patients
(Table 1).

Participants reported better HbA1c reduction (64%) as the

primary factor that makes vildagliptin better than other
DPP4 inhibitors like sitagliptin and teneligliptin, followed
by a reduced likelihood of causing hypoglycemia (50%)
(Table 1). Figure 1: Order of preference to add vildagliptin with
other OADs.
When asked about their preference for adding vildagliptin Ranked on a scale of 1 -9 as per their preference, where
with OADs, participants preferred adding it mainly to preference decreased from 1 to 9. SGLT-2: sodium-glucose
metformin (3.1), followed by metformin and SGLT2 transporter-2, SU: sulfonylurea
inhibitor combination (4.0). Vildagliptin addition to
metformin, sulfonylurea, and pioglitazone combination Most participants (64%) reported that inadequate HbA1c
was the least preferred (6.8) (Figure 1). control is the most common trigger for switching to
vildagliptin and metformin or other combinations from
Attitude or perception about vildagliptin and its vildagliptin (Table 2).
combination
When asked about which patient profile would benefit the
Most participants (75%) indicated that insufficient HbA1c most from vildagliptin monotherapy, the participants
control was the primary reason for switching to reported treatment-naive T2DM patients (64%), patients
vildagliptin from other oral-antidiabetic (OAD) agents. with uncontrolled T2DM with metformin monotherapy
Additionally, some of them (36%) reported hypoglycemia (54%), and patients with uncontrolled T2DM on dual
with existing treatment as another factor for switching to therapy of sulfonylurea and metformin (50%) were among
vildagliptin from other OADs (Table 2). those likely to benefit (Table 2).

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Table 2: Attitude or perception about vildagliptin. Similarly, when asked about which patient profiles would
benefit from the vildagliptin and metformin combination,
S. Percentage the participants reported that treatment-naïve T2DM
Questions
no. of HCPs patients with HbA1c 1.5% above target (61%), patients
What are the trigger factors that make you switch with uncontrolled T2DM either on dual therapy of
to vildagliptin from other treatments patients are sulfonylurea and metformin (54%) or on metformin
on? monotherapy (54%) were among those likely to benefit
Inadequate HbA1c control 75 (Table 2).
1
Hypoglycemia 36
High-age patients 18 The majority of participants (89%) reported that they
Comorbidity 14 would prefer adding DPP-4 inhibitors for patients with
Low-age patients 7 uncontrolled T2DM on metformin and sulfonylurea
therapy followed by SGLT2 inhibitors (18%), pioglitazone
What are the trigger factors that make you switch
(7%), voglibose (7%), and GLP-1 analogs (7%) (Table 2).
from vildagliptin to vildagliptin-metformin or
any other combination?
In response to inquiries about the potential for vildagliptin
Inadequate HbA1c control 64
2. to replace other OADs in the future, the majority of
Hypoglycemia 36 participants (46%) indicated it could replace teneligliptin,
High-age patients 14 followed by sitagliptin (39%), and glimepiride (32%).
Comorbidity 7 Some also indicated the possibility of other OADs also
Low-age patients 0 being replaced by vildagliptin (Table 2).
Which patient type would benefit from
vildagliptin monotherapy? Practice assessment for vildagliptin and its combination
Treatment-naïve T2DM patients 64
Uncontrolled T2DM patient on The majority of participants (57%) prescribed the 50 mg
3. 54 twice daily (BID) dose of vildagliptin, while the rest
dual therapy of SU + metformin
T2DM patients uncontrolled on prescribed the 100 mg once daily (OD) dose (Table 3).
50
metformin monotherapy
Obese T2DM patients 11 Most participants (61%) noted a glycemic reduction of
Which patient type would benefit from 1.0–1.5% when using vildagliptin with metformin. Others
vildagliptin and metformin combination therapy? reported reductions of 0.5 to 1% and 1.5 to 2.5%. Only a
Treatment-naive T2DM patients proportion reported reductions exceeding 2.5% (Table 3).
61
with HbA1c 1.5% above target
4 Uncontrolled T2DM patients on Table 3: Practice-related aspects for vildagliptin.
54
dual therapy of SU and metformin
S. Percentage
T2DM patients uncontrolled on Questions
54 no. of HCPs
metformin monotherapy
Which vildagliptin dosing form do you
Obese T2DM patients 11
prescribe the most?
Which class of drug would you like to add in 1
Vildagliptin 50 mg BID 57
patients uncontrolled on metformin and SU?
Vildagliptin 100 mg OD 43
DPP4 inhibitors 89
As per your clinical experience, how much
5 SGLT2 inhibitors 18 reduction occurs in glycaemic parameters with
Pioglitazone 7 vildagliptin + metformin from baseline?
Voglibose 7 2 0.5 to 1% 18
GLP-1 analogues 7 >1 to 1.5% 61
Do you think vildagliptin can replace any oral >1.5 to 2.5% 21
anti-diabetic in the future? >2.5% 4
Teneligliptin 46 BID: Twice daily, OD: once daily
Sitagliptin 39
Glimepiride 32 DISCUSSION
Gliclazide 29
6.
Metformin 25 DPP-4 inhibitors have established themselves as an
Voglibose 25 important class of oral antidiabetic drugs for managing
Linagliptin 25 T2DM.14 These inhibitors have been integrated into the
Dapagliflozin 7 treatment protocols outlined in numerous national and
Empagliflozin 7 international guidelines for T2DM.14
Remogliflozin 4

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Vildagliptin exerts its effects as a potent and selective safety profiles of both drugs support their combined use.28
inhibitor of the DPP-4 enzyme. The efficacy of Several trials have evaluated vildagliptin as an additional
vildagliptin in reducing HbA1c levels has been established therapy to metformin.26-28
in clinical studies. Additionally, its safety and tolerability
profile has been demonstrated to be superior to that of Most HCPs indicated inadequate HbA1c control with
sulfonylurea or thiazolidinedione therapy.15 This survey OADs as the most common trigger to switch to vildagliptin
focused on the knowledge, attitude, and practice of followed by a lower risk of hypoglycemia. Several studies
healthcare professionals on the use of vildagliptin in have demonstrated the efficacy of vildagliptin as an add-
routine clinical practice. on in patients who were inadequately controlled with
metformin monotherapy and the occurrence of
Knowledge about vildagliptin and its combination hypoglycemia was rare.27,29,30 The efficacy of vildagliptin
in combination with other antidiabetic drugs like
American Association of Clinical Endocrinologists pioglitazone and insulin has also been demonstrated in
(AACE) recommends initiating monotherapy when the patients with insufficiently controlled T2DM with
initial HbA1c is below 7.5%, while dual therapy is monotherapy.30
suggested for an initial HbA1c level exceeding 7.5%.16,17
Around 50% of HCPs participating in this survey reported Attitudes or perceptions about vildagliptin and its
initiating vildagliptin monotherapy at an HbA1c of 6.5- combination
7.5% while another 46% reported initiated it initiating it at
HbA1c of 7.5-8.5%. This finding aligns with clinical Most HCPs mentioned inadequate HbA1c control as the
studies assessing the effectiveness of vildagliptin most common trigger for switching to vildagliptin and
monotherapy, which also reported that patients included in metformin from vildagliptin. Vildagliptin, as discussed
these studies typically had baseline HbA1c levels ranging earlier, can be used to intensify therapy in person
from 6.5% to 8.5%.18,19 uncontrolled on metformin with/without other glucose-
lowering drugs.12,31
The majority of HCPs prefer to initiate vildagliptin and
metformin combination at an HbA1c level of 7–8 in newly Most HCPs consider that vildagliptin monotherapy will
detected T2DM patients. Clinical studies assessing the mainly benefit treatment-naive T2DM patients, while
effectiveness of this combination also enrolled patients some consider that it will also benefit patients with
with a mean baseline HbA1c ranging from 7.3% to uncontrolled T2DM with metformin monotherapy.
8.1%.20-22 Various studies have demonstrated the efficacy of
vildagliptin in treatment-naïve patients as well as patients
Most HCPs find vildagliptin to be better than other DPP4 uncontrolled on metformin therapy.18,19,21
inhibitors due to its superior efficacy in reducing HbA1c
levels. Literature reports also indicate better HbA1c In the view of most HCPs, the treatment-naïve T2DM
reduction from the baseline with vildagliptin (-0.88%) than patients with HbA1c 1.5% above target benefit the most
sitagliptin (-0.79%), saxagliptin (-0.70%), linagliptin (- with the vildagliptin and metformin combination. This
0.55%), alogliptin (-0.76%) and teneligliptin (-0.8%- aligns with the ADA 2024 guidelines that mention patients
0.9%).23,24 Additionally, half of the participants indicated with HbA1c ≥1.5% above the glycemic target require dual
a low risk of hypoglycemia as a benefit compared to other combination therapy to achieve their target HbA1c level.32
DPP4 inhibitors. These inhibitors boost insulin secretion These guidelines also mention that initial combination
in a glucose-dependent manner, mitigating hypoglycemia therapy is better than the sequential addition of
risk when used alone or with other antidiabetic agents. medications for early management.32 The findings of the
Studies indicate that hypoglycemic risk in patients treated VERIFY study indicated that the incidence of initial
with vildagliptin or Alogliptin is similar to placebo when treatment failure (HbA1c value ≥7%) was lower in the
used alone or in combination with other agents like insulin vildagliptin-metformin combination treatment group
or sulfonylurea. Conversely, studies indicate an increased (43.6%) compared to the sequential treatment group
hypoglycemia risk when patients with background (62.1%).33 Furthermore, a real-world evidence study from
treatment with insulin or sulfonylurea are treated with India published in 2021 also demonstrated the efficacy of
sitagliptin, saxagliptin, or linagliptin.25 combination therapy in these patients.22

Most HCPs prefer adding vildagliptin most commonly to Many HCPs also reported that patients with uncontrolled
metformin. Literature reports indicate that vildagliptin has T2DM either on dual therapy of sulfonylurea and
been evaluated as add-on therapy with metformin, metformin or on metformin monotherapy also benefit from
sulfonylureas, thiazolidinediones, and insulin treatment this combination. Various studies have demonstrated that
and in initial combination with pioglitazone.26, 27 HbA1c reduction with vildagliptin and metformin was
Vildagliptin and metformin demonstrate synergistic similar to sulfonylurea and metformin combination.21,34,35
effects, with vildagliptin stimulating β-cells in a glucose- Alternatively, based on the findings of a study comparing
dependent manner and metformin enhancing insulin results from randomized controlled trials (RCTs) with
sensitivity. Moreover, the well-established favorable observational studies and real-life data, it appears that the

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decrease in HbA1c from baseline with sulfonylurea metformin combination therapy was associated with
treatment is smaller in real-life settings compared to RCTs. favourable reductions in glycemic parameters.
In contrast, the reduction observed with vildagliptin when Vildagliptin as a monotherapy or in combination with
added to metformin remains essentially the same, metformin is effective in diverse patient groups. Overall,
indicating that vildagliptin retains its full treatment vildagliptin plays an important role in optimizing glycemic
efficacy in real-life scenarios, unlike sulfonylureas, control in T2DM management and this survey highlights
potentially due to concerns regarding hypoglycemia.36 its clinical utility in routine practice.
Likewise, clinical evidence supports the finding from this
survey that vildagliptin and metformin offer better ACKNOWLEDGEMENTS
glycemic control in patients inadequately controlled with
metformin monotherapy.22,28,36 The authors gratefully acknowledge and thank the 1, 440
healthcare professionals across India who participated in
The majority of HCPs reported that they would prefer this survey.
adding DPP-4 inhibitors for patients with uncontrolled
T2DM on metformin and sulfonylurea therapy. This Funding: The study was funded by Alembic
finding is supported by the literature reports where the Pharmaceuticals Ltd
combination of DPP-4 inhibitor, metformin, and a Conflict of interest: Dr. Sanjay Jain and Dr. Heena
sulfonylurea is effective in achieving glycemic control.37,38 Bhojwani are full-time employees of Alembic
Pharmaceuticals Ltd, which actively markets Vildagliptin
The majority of HCPs reported that vildagliptin may Ethical approval: Not required
replace teneligliptin in the future while some reported that
it may replace glimepiride as well. Although it is difficult REFERENCES
to comment on whether vildagliptin can replace these
drugs, there are some advantages that vildagliptin offers 1. Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha
over them. For example, vildagliptin offers a slightly better Fernandes JD, Ohlrogge AW, et al. IDF Diabetes
reduction in HbA1c compared to teneligliptin.23,24 Atlas: Global estimates of diabetes prevalence for
Furthermore, vildagliptin has a low risk of hypoglycemia 2017 and projections for 2045. Diabetes Res Clin
and is weight-neutral, unlike sulfonylureas which are Pract. 2018;138:271-81.
associated with hypoglycemia and weight gain.7 2. World Health Organization. The top 10 causes of
death. Available at: https://www.who.int/en/news-
Practice assessment for vildagliptin and its combination room/fact-sheets/detail/the-top-10-causes-of-death.
Accessed on 06 March 2024.
Vildagliptin dosage is either 50 mg BID or 100 mg OD. 3. Tao Z, Shi A, Zhao J. Epidemiological Perspectives
Both dosage regimens result in a similar glycemic of Diabetes. Cell Biochem Biophys. 2015;73(1):181-
reduction.39 In this survey, the preference for either dose 5.
did not differ much, but 50 mg BID was prescribed by 4. Pradeepa R, Mohan V. Epidemiology of type 2
more HCPs. diabetes in India. Indian J Ophthalmol.
2021;69(11):2932-8.
Several studies have demonstrated the efficacy of the 5. Pradeepa R, Mohan V. Prevalence of type 2 diabetes
vildagliptin and metformin combination.34 The findings of and its complications in India and economic costs to
the present survey indicated a 1.0-1.5% glycemic the nation. Eur J Clin Nutr. 2017;71(7):816-24.
reduction with vildagliptin and metformin. In a study by 6. IDF Diabetes Atlas 10th edition. Available at:
Gaal et al, the HbA1c reduction was reported to be 0.8% https://diabetesatlas.org/idfawp/resource-
and 1.0% after 105 and 180 days of treatment with the files/2021/07/IDF_Atlas_10th_Edition_2021.pdf.
combination, respectively.15 Furthermore, Hong et al Accessed on 06 March 2024.
reported that the adjusted mean HbA1c levels decreased 7. Keating GM. Vildagliptin: a review of its use in type
by 1.19% after 24 weeks of treatment.40 Thus, the findings 2 diabetes mellitus. Drugs. 2014;74(5):587-610.
of this survey align with the existing evidence. 8. Stamataros G, Schneider SH. Vildagliptin in the
treatment of type 2 diabetes mellitus. Expert Opin
Despite limitations like close-ended questions, and recall Pharmacother. 2011;12(12):1967-73.
bias, this survey has highlighted interesting views about 9. Samraj GP. Vildagliptin for the treatment of diabetes.
the use of vildagliptin and its combination, which mainly Clin Pract. 2011;8(6):703.
align with the existing evidence. 10. Das S, Gupta AK, Bandyopadhyaya B, Darla BH,
Arya V, Abhyankar M, et al. Data on vildagliptin and
CONCLUSION vildagliptin plus metformin combination in type-2
diabetes mellitus management. Bioinformation.
2021;17(3):413-23.
This KAP survey was conducted across the country with
11. Kalra S, Zargar AH, Sridhar GR, Das AK, Ahmed J,
experienced HCPs responding to the questionnaire.
Mohan JC, et al. Expert eValuation of Efficacy and
Vildagliptin was perceived favourably due to its efficacy
Rationality of Vildagliptin "EVER-Vilda": An Indian
and lower risk of hypoglycemia. Vildagliptin and

International Journal of Research in Medical Sciences | August 2024 | Vol 12 | Issue 8 Page 6
 Kalra P et al. Int J Res Med Sci. 2024 Aug;12(8):xxx-xxx

Perspective. Clin Med Insights Endocrinol Diabetes. estimate the HbA1c response to different DPP-4
2024;17:11795514231203911. inhibitors in type 2 diabetes: a systematic review and
12. Samajdar SS, Mukherjee S, Sarkar S, Sen S, Tripathi meta-analysis of 98 trials with 24 163 patients. BMJ
SK, Joshi SR. Availability of different branded Open. 2015;5(2):e005892.
generic vildagliptin after off-patenting: An 24. Chudiwal TB. Comparative effect of vildagliptin and
observation from India. J Diabetol. 2023;14:236-8. teneligliptin on HbA1c, glycemic efficacy and
13. Shah AP, Parmar SA, Ramkishan A, Mehta AA. insulin sensitivity. Int J Basic Clin Pharmacol.
Knowledge, attitude, and practice (KAP) survey 2017;6:1682-8.
regarding the safe use of medicines in rural area of 25. Karagiannis T, Boura P, Tsapas A. Safety of
Gujarat. Adv Trop Med Pub Health Int. dipeptidyl peptidase 4 inhibitors: a perspective
2011;1(2):66-70. review. Ther Adv Drug Saf. 2014;5(3):138-46.
14. Gallwitz B. Clinical Use of DPP-4 Inhibitors. Front 26. Gupta V, Kalra S. Choosing a gliptin. Indian J
Endocrinol (Lausanne). 2019;10:389. Endocrinol Metabolism. 2011;15(4):298-308.
15. Van Gaal L, Hermans MP, Daci E, Denhaerynck K, 27. Kalra S. Emerging role of dipeptidyl peptidase-IV
De Meester L, MacDonald K, et al. Effectiveness and (DPP-4) inhibitor vildagliptin in the management of
Tolerability of Vildagliptin and the Single Pill type 2 diabetes. J Assoc Physicians India.
Combination of Vildagliptin and metformin in "Real- 2011;59(2):237-45.
World" Management of Type 2 Diabetes Mellitus: 28. Ding Y, Liu Y, Qu Y, Lin M, Dong F, Li Y, et al.
The G-FORCE Study. Diabetes Ther. Efficacy and safety of combination therapy with
2019;10(3):965-79. vildagliptin and metformin vs. metformin
16. Samson SL, Vellanki P, Blonde L, Christofides EA, monotherapy for Type 2 Diabetes Mellitus therapy: a
Galindo RJ, Hirsch IB, et al. American Association meta-analysis. Eur Rev Med Pharmacol Sci.
of Clinical Endocrinology Consensus Statement: 2022;26(8):2802-17.
Comprehensive Type 2 Diabetes Management 29. Maladkar M, Sankar S, Darshanwad M. The Journey
Algorithm - 2023 Update. Endocr Pract. of Vildagliptin: From Bench to Bedside. The Indian
2023;29(5):305-40. Practitioner. 2022;75(4):28-36.
17. Das AK, Saxena G, Naik S. HbA1C in Management 30. Pan C, Wang X. Profile of vildagliptin in type 2
of Type II Diabetes Mellitus: A Cross-sectional diabetes: efficacy, safety, and patient acceptability.
Survey of Indian Physicians. J Assoc Physicians Ther Clin Risk Mana.g 2013;9:247-57.
India. 2019;67(7):18-21. 31. Rosenstock J, Fitchet M. Vildagliptin: clinical trials
18. Scherbaum WA, Schweizer A, Mari A, Nilsson PM, programme in monotherapy and combination therapy
Lalanne G, Jauffret S, et al. Efficacy and tolerability for type 2 diabetes. Int J Clin Pract Suppl.
of vildagliptin in drug-naïve patients with type 2 2008;159:15-23.
diabetes and mild hyperglycaemia. Diabetes Obes 32. American Diabetes Association Professional Practice
Metab. 2008;10(8):675-82. Committee. 9. Pharmacologic Approaches to
19. Pi-Sunyer FX, Schweizer A, Mills D, Dejager S. Glycemic Treatment: Standards of Care in Diabetes-
Efficacy and tolerability of vildagliptin monotherapy 2024. Diabetes Care. 2024;47(1):S158-78.
in drug-naïve patients with type 2 diabetes. Diabetes 33. Matthews DR, Paldánius PM, Proot P, Chiang Y,
Res Clin Pract. 2007;76(1):132-8. Stumvoll M, Del Prato S, et al. Glycaemic durability
20. Garber AJ, Foley JE, Banerji MA, Ebeling P, of an early combination therapy with vildagliptin and
Gudbjörnsdottir S, Camisasca RP, et al. Effects of metformin versus sequential metformin monotherapy
vildagliptin on glucose control in patients with type in newly diagnosed type 2 diabetes (VERIFY): a 5-
2 diabetes inadequately controlled with a year, multicentre, randomised, double-blind trial.
sulphonylurea. Diabetes Obes Metab. Lancet. 2019;394(10208):1519-29.
2008;10(11):1047-56. 34. Summary of product characteristics. Available at
21. Ferrannini E, Fonseca V, Zinman B, Matthews D, Galvus, INN-vildagliptin (europa.eu). Accessed on
Ahrén B, Byiers S, et al. Fifty-two-week efficacy and 16 April 2024.
safety of vildagliptin vs. glimepiride in patients with 35. Kumar S. Comparison of Safety and Efficacy of
type 2 diabetes mellitus inadequately controlled on Glimepiride-Metformin and Vildagliptin- Metformin
metformin monotherapy. Diabetes Obes Metab. Treatment in Newly Diagnosed Type 2 Diabetic
2009;11(2):157-66. Patients. Indian J Endocrinol Metab. 2021;25(4):326-
22. Mohan V, Zargar A, Chawla M, Joshi A, Ayyagari 31.
U, Sethi B, et al. Efficacy of a Combination of 36. Bosi E, Camisasca RP, Collober C, Rochotte E,
Metformin and Vildagliptin in Comparison to Garber AJ. Effects of vildagliptin on glucose control
Metformin Alone in Type 2 Diabetes Mellitus: A over 24 weeks in patients with type 2 diabetes
Multicentre, Retrospective, Real-World Evidence inadequately controlled with metformin. Diabetes
Study. Diabetes Metab Syndr Obes. 2021;14:2925- Care. 2007;30(4):890-5.
33. 37. Hirao K, Maeda H, Shirabe S, Yamamoto R, Hirao
23. Esposito K, Chiodini P, Maiorino MI, Capuano A, T, Hirao S, et al. Combination Therapy with a
Cozzolino D, Petrizzo M, et al. A nomogram to Dipeptidyl Peptidase-4 Inhibitor, Sulfonylurea, and

International Journal of Research in Medical Sciences | August 2024 | Vol 12 | Issue 8 Page 7
 Kalra P et al. Int J Res Med Sci. 2024 Aug;12(8):xxx-xxx

Metformin Markedly Improves HbA1c Levels in on therapy and sulfonylurea dose-increasing therapy
Japanese Patients with Type 2 Diabetes Mellitus. Jpn in patients with inadequately controlled type 2
Clin Med. 2012;3:1-7. diabetes using metformin and sulfonylurea (VISUAL
38. Owens DR, Swallow R, Dugi KA, Woerle HJ. study): A randomized trial. Diabetes Res Clin Pract.
Efficacy and safety of linagliptin in persons with type 2015;109(1):141-8.
2 diabetes inadequately controlled by a combination
of metformin and sulphonylurea: a 24-week Cite this article as: Kalra P, Dharmalingam M,
randomized study. Diabet Med. 2011;28(11):1352- Kubba S, Bhojwani H, Jain S. Role of vildagliptin
61. and its combination in type 2 diabetes mellitus
39. Henness S, Keam SJ. Vildagliptin. Drugs. management: a knowledge, attitude, and practice
2006;66(15):1989-2001. survey among Indian healthcare professionals. Int J
40. Hong AR, Lee J, Ku EJ, Hwangbo Y, Kim KM, Res Med Sci 2024;12:xxx-xx.
Moon JH, et al. Comparison of vildagliptin as an add-

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