Expert viewpoint on the position of Vildagliptin in a cardiology clinic in Indian clinical settings

Objective: To analyze the opinion of Indian clinical experts on the current usage patterns of vildagliptin in the treatment of patients with type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Methods: This report summarizes opinions and discussions that occurred during the 36 virtual round table meetings (May 2021 - March 2022) involving 540 healthcare practitioners (HCPs) across India. The collected data were analyzed and categorized into four grades: Level A, very strong (≥80% responses); Level B, strong (≥50-79% responses); Level C, moderate (25-49% responses); Level D, neutral/no consensus (<25% responses). Results: Healthcare practitioners gave opinions for the following; Level A (90.9%): time-in-range (TIR) and glycemic variability are important clinical criteria for selecting antidiabetic therapy in patients with risks of macrovascular complications; Level B (70.8%): vildagliptin gives better TIR and less glycemic variability compared to other dipeptidyl peptidase-4 inhibitors; Level A (90.9%): addition of vildagliptin should be considered in patients with T2DM and established atherosclerotic CVD who have uncontrolled glycemia with metformin plus sodium-glucose cotransporter-2 inhibitors treatment; Level B (52.9%): Vildagliptin should be considered as a part of the treatment algorithm only when the patient population is elderly, with long-standing diabetes, newly diagnosed T2DM with prior CVD, patients with obesity, or renal impairment. The majority of HCPs reported clinical benefits including a reduction in the dose of insulin (52.4%) and the number of hypoglycemic incidences (33.3%) with vildagliptin plus insulin. Conclusion: Indian clinical experts recommended the safe and neutral use of vildagliptin in patients with T2DM and CV risk and/or CVD.