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

Abstract

The combination of dapagliflozin (DAPA; a sodium-glucose cotrans-porter-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 declin-ing 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.