Validation of RSSDI therapeutic wheel with clinical experience of Indian physicians

• Published in: International journal of diabetes in developing countries 2022-07, Vol.42 (3), p.451-458
• Main Authors: Hasnani, Dhruvi, Chavda, Vipul, Agrawal, Dinesh, Patni, Bijay, David, Ashwin, Gathe, Sachin, Chawla, Rajeev, Kesavadev, Jothydev, Gupta, Sunil, Hasnani, Shriji, Saboo, Banshi
• Format: Article
• Language: English
• Subjects: Diabetes; Diabetes mellitus (non-insulin dependent); Family Medicine; General Practice; Health Administration; Hypoglycemic agents; Insulin; Medicine; Medicine & Public Health; Metformin; Original Article; Patients; Risk factors
• ISSN: 0973-3930; 1998-3832
• DOI: 10.1007/s13410-021-00998-6

Background The Research Society for Study of Diabetes in India (RSSDI) has developed country-specific guidelines focusing on patient-centric approach for effective management of type 2 diabetes mellitus(T2DM) depending on modifiable and non-modifiable risk factors and pre-existing complications (ABCDEFG). Methods We conducted a multicenter, retrospective real world study ( n  = 780) to validate the use of RSSDI therapeutic wheel by using individually preferred guidelines and clinical expertise of Indian physicians. Result In elderly population (> 60 years), most commonly prescribed oral hypoglycemic agents (OHA) were DPP-4i (91.23%), metformin (74.74%), sulfonylureas (66.49%), and SGLT-2i (56.18). In patients with BMI > 30 kg/m 2 ( n  = 133), order of preference was metformin (92.48%), DPP-4i (34.58%), and SGLT-2i (34.58%). In patients with eGFR 30–45 ml/min/1.73 2 ( n  = 32), metformin (81.25%), DPP-4i (40.63%), and SGLT-2i (40.63%) were prescribed. Analysis of prescription pattern according to baseline glycemic status (n = 380) shows most commonly prescribed OHA in patients with HbA1c > 10% ( n  = 144) were metformin ( n  = 144, 100%), sulfonylureas ( n  = 75, 52.08%), insulin ( n  = 74, 51.38%), and DPP-4i ( n  = 71, 50%). We observed increasing use of DPP-4i (43.33% for  10 years), SGLT-2i (30% for  10 years), insulin (20% for  10 years), and AGI (6.66% for  10 years) with increasing duration of diabetes. Most commonly prescribed drugs in T2DM with CVD were metformin (81.30%), DPP-4i (49.59%), and insulin (34.96%). In patients with limited financial status, metformin (67.70%), sulfonylureas (45.07%), and insulin (39.43%) were commonly used. The findings from prescriptions prescribed after identifying the most important factors (ABCDEFG) helped in obtaining better glycemic control among these subjects. This validated the suggestions of RSSDI therapeutic wheel. Conclusion Physicians can adopt RSSDI therapeutic wheel for simple patient centric and effective management of T2DM.