Drivers of vildagliptin prescription for Romanian patients with type 2 diabetes, the TREND study
Background and aims: Vildagliptin is a dipeptidyl-peptidase-4 inhibitor, used in the treatment of Type 2 Diabetes Mellitus, associated with a slightly better HbA1c reduction compared to other molecules in its class, who may be used, in adjusted dose, irrespective the estimated glomerular filtration rate, including in end-stage kidney disease and which demonstrated an excellent safety profile. Vildagliptin is fully reimbursed in Romania within the National Diabetes Program. The main aim of this study was to evaluate which are the most important Vildagliptin’s prescription drivers. Material and methods: In this cross-sectional, non-interventional study data for 1918 patients in who Vildagliptin treatment was considered was collected in a consecutive-case population-based scenario. Data were collected from 106 diabetologists working in 61 cities from 36 Romanian counties. The median cases completed by a doctor was 18 (ranging from 1 to 31 responses, inter quartile range between 15 and 20). Results: The majority of Vildagliptin’s associations were to prior Metformin treatment (83.6% of the cases), among who in 48.7% of the cases Vildagliptin was added as early as possible to maximize the benefit according to the VERIFY study results. In 9.6% of the cases Vildagliptin was associated to sulfonylurea. In prescribing Vildagliptin, the most important driver was the improvement of glycemic control, considered by 72.6% of the responders as being extremely important, followed by the importance of cardiovascular protection (65.5% - extremely important), hypoglycemia avoidance (61.9% - extremely important) and the possibility of safely use in chronic kidney disease (59.1% - extremely important). 59.9% of the responders considered appropriate to intensify the diabetes therapy with Vildagliptin after 3 months of Metformin treatment and 31.2% considered adequate to add Vildagliptin right at the T2DM diagnosis alongside Metformin if this would have been possible in the reimbursement algorithm. Conclusions: Vildagliptin is considered a valuable intervention in the treatment of T2DM, its benefits being emphasized in case of its early use in the course of T2DM. The most important factor in considering Vildagliptin for a patient is the improvement of the glycemic control. The excellent safety profile and possibility to use irrespective of eGFR is considered a key advantage for Vildagliptin.