Triple oral therapy with metformin, DPP-4 inhibitor, and SGLT2 inhibitor for adults with type 2 diabetes: Consensus recommendations of a Chinese expert panel (version 2025)
Abstract
Type 2 diabetes mellitus (T2DM) is a progressive disease involving multiple pathophysiologic defects, and combination therapy is often required to achieve and sustain glycaemic control. Triple oral therapy with metformin, dipeptidyl peptidase-4 inhibitors (DPP-4i), and sodium-glucose cotransporter-2 inhibitors (SGLT2i) has demonstrated high and durable glycaemic-lowering efficacy, favourable safety and tolerability, and additional metabolic benefits in T2DM patients with diverse background therapies, including those who are treatment-naïve and those with inadequate control on monotherapy or dual therapy. In light of the increasing clinical use of this triple regimen and the absence of established consensus to guide its use, the Diabetes Committee of the Chinese Research Hospital Association convened an expert panel comprising endocrinologists and evidence-based experts. Through a systematic literature review and a Delphi process, the panel formulated 11 consensus recommendations (8 strong and 3 weak recommendations) on the clinical use of metformin + DPP-4i + SGLT2i, including fixed-dose combination formulations. Safety considerations regarding its use were also described. This consensus aimed to provide clinicians with practical guidance to optimize the effective and safe use of metformin + DPP-4i + SGLT2i in T2DM management.
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