Evergreen Talk Series: Combination of Linagliptin and Dapagliflozin in T2DM with multiple episodes of hypoglycemia

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 their views about Linagliptin and Dapagliflozin combination in cases of T2DM with repeated hypoglycemia.

Dr Brij Mohan Makkar: Metformin, SGLT2i, and DPP4i, these are the molecules which do not cause hypoglycemia. Now, if they are used in people who are already on insulin and sulfonylurea, they may precipitate hypoglycemia because of the onboard insulin and sulfonylurea. So, as far as hypoglycemia is concerned, it is not a challenge when you're using Linagliptin and dapagliflozin in combination. 

Dr Sameer I Dani: Linagliptin, as a monotherapy or as an addition to metformin or even dapagliflozin, has been shown to cause very minimal episodes of hypoglycemia, even in drug-naïve patients. Linagliptin use has been shown to have better efficacy than metformin monotherapy. In fact, Linagliptin and dapagliflozin not only have better efficacy but also robust safety evidence and very durable renal safety results. Additionally, Linagliptin could be preferred in a wide range of type 2 diabetic patients. In fact, in most diabetic patients, you can use the Linagliptin and dapagliflozin combination very easily, which highlights the wide applicability of this combination.

Dr Tukaram Jamale: Hypoglycemia is very, very common once kidney disease is observed because once GFR starts decreasing, the overall requirement of oral hypoglycemic agents decreases, including insulin. This is due to the increased half-life of insulin, as physiological excretion through the kidneys decreases. In such situations, most oral hypoglycemic agents like sulfonylureas, which are one of the most common agents prescribed, pose a high risk of producing hypoglycemia unless doses are appropriately modified. However, such risks are manageable and not very significant. With DPP-4 inhibitors and SGLT2 inhibitors, we hardly see hypoglycemia. Therefore, they are among the safest agents to use when there is an elevated risk of hypoglycemia and chronic kidney disease.