Real-World Prescribing Patterns, Dose Selection and Administration Frequency of SGLT-2 and DPP-4 Inhibitors in Patients with Type 2 Diabetes Mellitus: A 12-Month Prospective Observational Study

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Background: Sodium-glucose cotransporter-2 (SGLT-2) and dipeptidyl peptidase-4 (DPP-4) inhibitors represent pharmacologically distinct antihyperglycemic modalities extensively utilized in type 2 diabetes mellitus (T2DM). Characterization of real-world pharmacoutilization, encompassing agent selection, dosage-strength distribution, and administration periodicity, provides insight into prevailing prescribing practices. Objective: To delineate the real-world utilization profile of individual SGLT-2 and DPP-4 inhibitors, with particular emphasis on agent selection, dose-strength distribution, and administration frequency among patients with T2DM receiving routine clinical care. Methods: A prospective, observational comparative cohort study was conducted among patients receiving either therapeutic class. Of 763 individuals screened, 684 consented and entered the study, with 342 participants in each therapeutic cohort. Prespecified clinical assessments were undertaken at baseline and at 3, 6, 9, and 12 months. At study completion, 250 participants in each cohort fulfilled the requisite follow-up assessments and constituted the complete-case analytical population. Prescribed agents, dosage strengths, and administration schedules were systematically documented and descriptively characterized. Results: Within the SGLT-2 cohort, dapagliflozin, canagliflozin, and empagliflozin constituted 90 (36%), 75 (30%), and 85 (34%) prescriptions, respectively. Dapagliflozin was prescribed at 5 mg in 35 (14%) and 10 mg in 55 (22%); canagliflozin at 100 mg in 40 (16%) and 300 mg in 35 (14%); and empagliflozin at 10 mg in 50 (20%) and 25 mg in 35 (14%). All SGLT-2 regimens were administered once daily. Among DPP-4 recipients, sitagliptin, vildagliptin, linagliptin, and saxagliptin constituted 80 (32%), 60 (24%), 55 (22%), and 55 (22%), respectively. Vildagliptin was administered once daily in 20 (8%) and twice daily in 40 (16%), whereas the remaining DPP-4 regimens were administered once daily. Conclusion: The prescribing profile demonstrated distinct intraclass pharmacotherapeutic heterogeneity, encompassing variation in molecular selection and dosage-strength utilization. Administration periodicity remained uniform across SGLT-2 regimens, whereas DPP-4 therapy exhibited greater dosing variability, attributable predominantly to vildagliptin. These findings delineate the medication-utilization architecture characterizing routine clinical-care practice.