Real-World CGM Comparison of Teneligliptin+Dapagliflozin, Sitagliptin+Dapagliflozin, and Linagliptin+Empagliflozin in Indian T2DM: Amplify-TIR Study

Introduction: Diabetes mellitus (DM) is a chronic metabolic disorder marked by persistent hyperglycemia. While HbA1c has traditionally been used to assess glycemic control, growing evidence highlights glycemic variability (GV) and Time in Range (TIR) as more precise indicators of glucose fluctuations, which are linked to diabetic complications, especially chronic kidney disease (CKD). Emerging combination therapies targeting different pathophysiologic mechanisms of type 2 diabetes mellitus (T2DM), such as Sodium-glucose cotransporter (SGLT) 2 inhibitors and dipeptidylpeptidase (DPP)-4 inhibitors, offer promise in reducing glycemic variability. Objective: To compare the efficacy of three commonly prescribed fixed-dose combination (FDC) therapies— Teneligliptin + Dapagliflozin (Arm-A), Sitagliptin + Dapagliflozin (Arm-B), and Linagliptin + Empagliflozin (Arm-C)—in improving glycemic control and renal parameters in Indian type 2 diabetes mellitus (T2DM) patients using continuous glucose monitoring (CGM). Method: This prospective, comparative study enrolled 90 patients (30 in each arm). continuous glucose monitoring (CGM)  was used to evaluate glycemic parameters including time-in-range [TIR], Time Above Range [TAR]), Time Below Range [TBR], Mean Amplitude of Glycemic Excursions (MAGE), Largest Amplitude of Glycemic Excursions (LAGE), Meanpost-prandial glycemic excursions (MPPGE), HbA1c, FPG, PPG, and renal function indicators (eGFR, serum creatinine, BUN) at baseline and study conclusion. Results: All arms demonstrated significant improvements in time-in-range [TIR], MeanAmplitude of Glycemic Excursions (MAGE), Largest Amplitude of Glycemic Excursions (LAGE), HbA1c, FPG, and PPG (p<0.001). Arm-A showed a significantly superior reduction in Time Above Range [TAR]) and Mean post-prandial glycemic excursions (MPPGE) compared to Arm-B (p=0.029 and p=0.040, respectively)