Initial combination of metformin, sitagliptin, and empagliflozin in drug‐naïve patients with type 2 diabetes: Safety and metabolic effects
Abstract
Compared with traditional stepwise add-on therapy, proactive combination therapy with antidiabetic agents having a different mode of action has shown high efficacy for glycaemic control in patients with type 2 diabetes (T2D).1 A study using an initial triple combination with metformin, pioglitazone, and exenatide showed significantly better long-term glycaemic control than a conventional stepwise approach.2 Similarly, in Korean patients, initial triple combination therapy with metformin, sitagliptin (a dipeptidyl peptidase-4 inhibitor [DPP-4i]), and lobeglitazone (a thiazolidinedione), showed superior achievement of HbA1c targets over conventional therapy with fewer adverse events.3 DPP-4is comprise a class of oral antidiabetic agents that block the enzyme DPP-4. The mechanism of a DPP-4i is to increase incretin levels and inhibit glucagon release, both of which potentiate insulin secretion, and decrease the gastric emptying rate and blood glucose levels. Sodium-glucose co-transporter-2 inhibitors (SGLT-2is) increase the urinary excretion of glucose, thereby promoting glycaemic control independent of insulin action.4 Recent cardiovascular outcome trials have shown the cardiovascular safety of DPP-4is and the cardiovascular benefit with SGLT-2is.5 The clinical benefits of using an SGLT-2i for patients with T2D include lowering blood pressure, weight loss, and a reduced risk of major adverse cardiovascular and renal events.6 Therefore, both types of agent are an attractive…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 1,006 participants or records.
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