Background and Rationale Type 2 Diabetes Mellitus is a progressive chronic disease requiring treatment intensification over time to maintain glycemic control

While Metformin is the established Firstline therapy its efficacy diminishes as insulin resistance and beta cell dysfunction worsen

This necessitates add on therapies 

The American Diabetes Association recommends several classes of drugs, including Dipeptidyl Peptidase 4 inhibitors and Sodium-Glucose Cotransporter2 inhibitors, for second line treatment.

        Vildagliptin a DPP4 inhibitor is a well established weight neutral agent with a good safety profile

       Remogliflozin etabonate is a newer SGLT2 inhibitor that not only improves glycemic control but also offers the additional benefits of weight loss and blood   pressure reduction

       Its availability at a lower cost in India makes it a potentially attractive and cost-effective option for a large patient population

While both drug classes are effective there is a lack of direct head to head comparative data between the established DPP4 inhibitor Vildagliptin and the newer more affordable SGLT2 inhibitor Remogliflozin especially within the Indian population

 This study aims to address this gap by directly comparing their efficacy and safety as add on therapy in patients with T2DM inadequately controlled with metformin

Objectives 

Primary Objective To compare the efficacy of vildagliptin and remogliflozin as add on therapy to metformin in patients with type 2 diabetes mellitus in terms of their effect on HbA1c levels

Secondary Objectives To compare the safety of vildagliptin and remogliflozin as add on therapy to metformin

 To compare the effect of vildagliptin and remogliflozin on lipid profile and body weight