Background: Early use of combination therapy in diabetes patients may lead to sustained glycemic control and thereby reduce the progression of diabetic complications. Given the limitation of the traditional stepwise intensification strategy, early combination therapy can be an effective approach. Therefore, this study aims to assess the real-world efficacy of a combination of metformin and vildagliptin in comparison to metformin alone in type 2 diabetes mellitus (T2DM) patients in India. Methods: This was an observational, retrospective, non-interventional study based on electronic medical records (EMRs) of 2740 T2DM patients, retrieved from 2010 onwards from 22 diabetes centres across India. Adult drug naïve patients with a 5-year history of T2DM treated with either metformin or a combination of metformin and vildagliptin for at least 3 months were considered for this study. Efficacy assessment was done to evaluate the post-treatment HbA1c levels and patients requiring additional oral antidiabetic drugs (OADs) at the time of follow-up visit. Patients were also analyzed for the occurrence of adverse events. Results: Out of the total, 2452 patients were in metformin only arm, and 288 patients were in metformin plus vildagliptin treatment arm. A more significant reduction in HbA1c level was observed in metformin plus vildagliptin arm than metformin only arm (median: − 0.5% vs 0%, respectively; p< 0.001). Patients requiring additional OAD at follow-up were significantly lesser in the metformin plus vildagliptin arm than the metformin only arm (15.6% vs 35.2%, respectively; p< 0.001). The adverse events were comparable across the two arms, and commonly reported adverse events were giddiness, fatigue and gastric discomfort. Conclusion: The findings of this EMR-based real-world study emphasizes the need for early initiation of combination therapy (metformin plus vildagliptin) over metformin monotherapy for achieving better glycemic control.

Despite revolutionizing diabetes care globally, continuous glucose monitoring (CGM) adoption in India remains limited, as a result of several economic, infrastructural, clinical, and sociocultural concerns. This narrative review aims to map unmet needs and propose practical, context-specific solutions. Continuous use of CGM remains the preferred approach for optimal glucose management and achieving long-term metabolic advantages, providing insights for proactive, data-driven, and preventive diabetes care. However, main barriers to CGM uptake include limited awareness among people with diabetes and healthcare providers, high costs, lack of reimbursement, limited device availability beyond major cities, and economic, infrastructural, and sociocultural access inequities across urban and rural populations. The psychological burden from frequent alarms, data fatigue, and stigma with noticeable or intrusive devices add to these challenges. Addressing these barriers necessitates a multifaceted strategy involving affordable, climate-adapted devices, interoperable digital ecosystems, India-specific reimbursement models, and robust educational infrastructure. The emergence of cost-effective CGM devices with a range of advanced features, such as predictive glucose algorithms and personalized pattern identification, is pivotal to this effort. These innovations improve clinical outcomes and quality of life by simplifying the user experience, addressing challenges, such as alarm fatigue while translating complex data into actionable insights, facilitating widespread CGM adoption in India.

Effective management of diabetes warrants accurate and regular monitoring of glucose levels to prevent serious diabetes-associated complications and long-term health consequences. Hence, achieving target glucose levels and maintaining adequate glycemic control is essential in diabetes to prevent episodes of hypoglycemia. Multiple glucose monitoring tools have been developed over time, each with differing degrees of precision, convenience, and real-time input. The management of diabetes has been considerably improved by using these various glucose monitoring devices, both in terms of treatment outcomes and patient quality of life. However, in India, the lack of awareness, patient education, availability, and affordability of glucose monitoring devices poses a significant concern resulting in poor adherence to glucose monitoring and low medication adherence thereby increasing disease burden. Consequently, there is an urgent need for healthcare professionals and policymakers in India to collaborate and address the challenges associated with glucose monitoring in patients with diabetes, while also providing recommendations to overcome these concerns. This recommendation article offers a comprehensive evaluation of various glucose monitoring tools available for use by patients suffering from different types of diabetes, explores the challenges associated with glucose monitoring in India, and also presents expert panel recommendations to enhance diabetes management effectively.

(1) Background: There is a high burden of poor glycemic control in the Indian population with type 2 diabetes mellitus (T2DM). Currently, the use of metformin sustained-release (SR)–vildagliptin fixed-dose combination (FDC) is very low as compared to metformin immediate-release (IR)–vildagliptin FDC which is associated with higher adverse events (AEs). Here, we present real-world effectiveness of metformin SR–vildagliptin FDC treatment in patients with T2DM; (2) Methods: This retrospective analysis was carried out from the medical records of adult T2DM patients visiting a single study center in India (December 2020–February 2021). A total of 10 patients (aged ≥20 years) were treated with vildagliptin 50 mg and metformin SR 500 mg FDC for 15 days. The treatment response was assessed by the percentage of time spent in the target glucose range (TIR at baseline and 15 days after treatment); (3) Results: The glycated hemoglobin (HbA1c) levels at baseline varied between 6.5% to 12%. The glycemic control improved in 70% of patients (mean increase in TIR: 18.9%). Treatment adherence was 100%. No gastrointestinal symptoms or AEs were reported; (4) Conclusions: Early intervention with metformin SR–vildagliptin FDC in patients with T2DM can ensure therapy compliance in terms of superior efficacy along with safety and tolerability. Key summary points: Early initiation of combination therapy helps in early achievement of glycemic goals; Early initiation of metformin and vildagliptin FDC results in significant glycemic control with good tolerability and compliance; Metformin SR–vildagliptin FDC has lower adverse events, compared to metformin IR–vildagliptin FDC; A case series of ten patients with T2DM treated with metformin SR–vildagliptin FDC is presented to assess the real-world effectiveness of this combination.

Fluid, electrolyte, and energy (FEE) management plays a crucial role in the recovery of patients with type 2 diabetes mellitus (T2DM) and prediabetes, especially during acute non-diarrheal illnesses. However, current diabetes management guidelines often lack specific recommendations on how to address the unique FEE needs of these patients, leading to potential gaps in managing dehydration and energy deficits. In this article, we aimed to develop practical consensus recommendations on the role of FEE management in persons with diabetes (PWDs). Modified Delphi consensus methodology was utilized to reach a consensus. A scientific committee comprising 11 experts from India formed the panel. Relevant clinical questions within four major domains were formulated for presentation and discussion: (i) burden of FEE deficits in PWDs; (ii) assessment of FEE deficits in PWDs; (iii) role of FEE management in the recovery of T2DM; and (iv) importance of sustained energy concepts in meeting the energy requirements of T2DM. The consensus level was classified as “Yes” (when ≥ 70% of participants agree/strongly agree or disagree/strongly disagree with a statement) and “No” (when < 70% of participants agree/strongly agree or disagree/strongly disagree with a statement). The questions that lacked agreement were discussed during the virtual meeting. The experts agreed that slow-release carbohydrates, such as isomaltulose, D-tagatose, and trehalose, offer an effective solution for meeting energy requirements while stabilizing blood glucose levels and reducing glycemic variability. Ready-to-drink formulations that combine electrolytes, fluids, and slow-release carbohydrates provide a balanced approach to hydration and energy needs, which is particularly beneficial for patients with T2DM who are experiencing dehydration. Incorporating tailored FEE recommendations into existing guidelines could significantly enhance patient care by ensuring optimal hydration, electrolyte balance, and glucose control. This approach would be especially beneficial for patients with comorbidities or those at a higher risk of dehydration, supporting improved recovery and metabolic stability.

To evaluate the correlation between continuous glucose monitoring (CGM)-derived metrics such as time in range (TIR) and time below range (TBR) and clinical parameters in Indian patients with type 2 diabetes mellitus (T2DM), providing insights into the effectiveness of CGM in this population. This is a single-center, retrospective-observational study of T2DM patients aged 18 or older years using the Freestyle Libre/Libre Pro CGM system. Demographic and clinical data of these patients were extracted from medical records, and glycemic metrics from CGM profiles. The study included 248 T2DM patients, of whom 72.98 % were male, with a mean age of 60.48 years and a mean HbA1c value of 8.319 %. Linear regression analysis revealed that TIR was significantly negatively associated with HbA1c values (coefficient=-6.746) and duration of diabetes (coefficient=-0.425). The body mass index (BMI) showed a positive association with TIR (coefficient=0.649; P = 0.032). For TBR, only HbA1c values showed a significant negative association (coefficient=-1.051; P = 0.009), whereas age, duration of diabetes, and BMI were not significant predictors. The study highlights the significant relationships between CGM-derived metrics (TIR and TBR), and clinical parameters in Indian patients with T2DM, and their effectiveness in identifying patients at risk of inadequate glycemic control.