PMID- 33532378 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210206 IS - 2249-4863 (Print) IS - 2278-7135 (Electronic) IS - 2249-4863 (Linking) VI - 9 IP - 11 DP - 2020 Nov TI - Fixed-dose combination in management of type 2 diabetes mellitus: Expert opinion from an international panel. PG - 5450-5457 LID - 10.4103/jfmpc.jfmpc_843_20 [doi] AB - Type 2 diabetes mellitus (T2DM) is a progressive disease with multifactorial etiology. The first-line therapy includes monotherapy (with metformin), which often fails to provide effective glycemic control, necessitating the addition of add-on therapy. In this regard, multiple single-dose agents formulated as a single-dose form called fixed-dose combinations (FDCs) have been evaluated for their safety, efficacy, and tolerability. The primary objective of this review is to develop practice-based expert group opinion on the current status and the causes of concern regarding the irrational use of FDCs, in Indian settings. After due discussions, the expert group analyzed the results from several clinical evidence in which various fixed combinations were used in T2DM management. The panel opined that FDCs (double or triple) improve patient adherence, reduce cost, and provide effective glycemic control and, thereby, play an important role in the management of T2DM. The expert group strongly recommended that the irrational metformin FDC's, banned by Indian government, should be stopped and could be achieved through active participation from the government, regulatory bodies, and health ministry, and through continuous education of primary care physicians and pharmacists. In T2DM management, FDCs play a crucial role in achieving glycemic targets effectively. However, understanding the difference between rational and irrational FDC combinations is necessary from the safety, efficacy, and tolerability perspective. In this regard, primary care physicians will have to use a multistep approach so that they can take informed decisions. CI - Copyright: (c) 2020 Journal of Family Medicine and Primary Care. FAU - Kalra, Sanjay AU - Kalra S AD - Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India. FAU - Das, A K AU - Das AK AD - Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India. FAU - Priya, G AU - Priya G AD - Department of Endocrinology, Fortis Hospital, Mohali, India. FAU - Ghosh, S AU - Ghosh S AD - Department of Endocrinology and Metabolism, IPGMER, Kolkata, West Bengal, India. FAU - Mehrotra, R N AU - Mehrotra RN AD - Department of Endocrinology, Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana, India. FAU - Das, S AU - Das S AD - Department of Endocrinology, Apollo Hospitals, Bhubaneswar, Odisha, India. FAU - Shah, P AU - Shah P AD - Department of Endocrinology and Diabetes Gujarat Endocrine Centre, Ahmedabad, Gujarat, India. FAU - Bajaj, S AU - Bajaj S AD - Department of Endocrinology, MLN Medical College, Allahabad, Uttar Pradesh, India. FAU - Deshmukh, V AU - Deshmukh V AD - Department of Endocrinology, Deshmukh Clinic and Research Centre, Pune, Maharashtra, India. FAU - Sanyal, D AU - Sanyal D AD - Department of Endocrinology, KPC Medical College, Kolkata, West Bengal, India. FAU - Chandrasekaran, S AU - Chandrasekaran S AD - Department of Endocrinology and Diabetes, Dr. Rela Institute of Medical Science (RIMC), Chennai, Tamil Nadu, India. FAU - Khandelwal, D AU - Khandelwal D AD - Department of Endocrinology and Diabetes, Maharaja Agrasen Hospital, New Delhi, India. FAU - Joshi, A AU - Joshi A AD - Department of Endocrinology, Kathmandu Diabetes and Thyroid Centre, Nepal. FAU - Nair, T AU - Nair T AD - Department of Cardiology, PRS Hospital, Trivandrum, Kerala, India. FAU - Eliana, F AU - Eliana F AD - Department of Internal Medicine, Faculty of Medicine, YARSI University, Jakarta, Indonesia. FAU - Permana, H AU - Permana H AD - Department of Internal Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia. FAU - Fariduddin, M D AU - Fariduddin MD AD - Department of Endocrinology of Bangabandhu Sheikh, Mujib Medical University, Dhaka, Bangladesh. FAU - Shrestha, P K AU - Shrestha PK AD - Department of Internal Medicine, Tribhuwan University Teaching Hospital, Kathmandu, Nepal. FAU - Shrestha, D AU - Shrestha D AD - Department of Endocrinologist, Norvic International Hospital, Kathmandu, Nepal. FAU - Kahandawa, S AU - Kahandawa S AD - Department of Endocrinology, Teaching Hospital Karapitiya, Galle, Sri Lanka. FAU - Sumanathilaka, M AU - Sumanathilaka M AD - Department of Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka. FAU - Shaheed, A AU - Shaheed A AD - Department of Internal Medicine, Indira Gandhi Memorial Hospital, Male, Maldives. FAU - Rahim, A A AU - Rahim AA AD - Department of Diabetes and Metabolism, Alexandria University, Alexandria, Egypt. FAU - Orabi, A AU - Orabi A AD - Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt. FAU - Al-Ani, A AU - Al-Ani A AD - Department of Internal Medicine, Hamad Hospital, Doha, Qatar. FAU - Hussein, W AU - Hussein W AD - Department of Endocrinology and Diabetes, Dr. Wiam Clinic, Royal Hospital, Awali Hospital, Bahrain. FAU - Kumar, D AU - Kumar D AD - Department of Endocrinology, NMC Specialty Hospital, Abu Dhabi, UAE. FAU - Shaikh, K AU - Shaikh K AD - Department of Diabetes, Faculty of Internal Medicine, Royal Oman Police Hospital, Muscat, Oman. LA - eng PT - Journal Article PT - Review DEP - 20201130 PL - India TA - J Family Med Prim Care JT - Journal of family medicine and primary care JID - 101610082 PMC - PMC7842427 OTO - NOTNLM OT - Fixed-dose combination OT - metformin OT - sulfonylureas OT - thiazolidinediones OT - type 2 diabetes COIS- There are no conflicts of interest. EDAT- 2021/02/04 06:00 MHDA- 2021/02/04 06:01 PMCR- 2020/11/30 CRDT- 2021/02/03 06:00 PHST- 2020/05/12 00:00 [received] PHST- 2020/06/14 00:00 [revised] PHST- 2020/08/03 00:00 [accepted] PHST- 2021/02/03 06:00 [entrez] PHST- 2021/02/04 06:00 [pubmed] PHST- 2021/02/04 06:01 [medline] PHST- 2020/11/30 00:00 [pmc-release] AID - JFMPC-9-5450 [pii] AID - 10.4103/jfmpc.jfmpc_843_20 [doi] PST - epublish SO - J Family Med Prim Care. 2020 Nov 30;9(11):5450-5457. doi: 10.4103/jfmpc.jfmpc_843_20. eCollection 2020 Nov.