Presenting the Evergreen Talk Series featuring Dr. Brij Mohan Makkar, a Senior Diabetologist and Obesity Specialist from Delhi, Dr Sameer I. Dani, an Interventional Cardiologist from Ahmedabad, and Dr. Tukaram Jamale, a Nephrologist and Kidney Transplant Physician who serves as the Head of the Department at KEM Hospital Mumbai. They provide their insights on the use of Linagliptin, Dapagliflozin, and Metformin for diabetic patients.
Bringing viewpoints from the different specialities of Diabetology, Cardiology and Nephrology they share the Clinical Considerations for Linagliptin and its combinations with Metformin and Dapagliflozin
Dr Brij Mohan Makkar: The advantage of having a Fixed-Dose Combination (FDC) is improved compliance, making therapy more effective. Now, when it comes to the use of combinations, I think there is hardly any scenario where I do not use the combination of Linagliptin and Metformin. In my practice, I am more aggressive and frequently use a combination of Metformin, DPP4, and SGLT2 inhibitors to begin with. The only scenarios where I would not use this combination are if there is any hypersensitivity to any of these molecules or if the patient is very elderly and frail, in which case, I refrain from using the initial combination of Metformin, DPP4, and SGLT2 inhibitors
Dr Sameer I Dani: All established CVD patients, particularly those with heart failure or those at high risk of developing HF, I would prefer Linagliptin with Dapagliflozin. This combination is suitable for heart failure patients across all stages of CKD. I would prefer Linagliptin with Metformin or Linagliptin monotherapy in all other cases of diabetes who are at very high risk of developing ASCVD or where dapagliflozin is not very useful, very thin patient or patient with high risk of established recurrent genital UTI.
Dr Tukaram Jamale: Unlike our previous thinking, where we used to stop Metformin as soon as serum creatinine goes above 1.4 or 1.5, that wisdom no longer holds true today. Currently, we consider it safe, provided that kidney function is stable, at least until the EGFR is less than 30 mL per minute. And, of course, if the patient is on a DPP4 inhibitor, it can be very well combined with Metformin, reducing the pill burden
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