Endocrinol Metab.  2024 Feb;39(1):23-32. 10.3803/EnM.2023.1816.

Initial Combination Therapy in Type 2 Diabetes

• Kim JY
• Kim NH

• KMID: 2552792
• DOI: http://doi.org/10.3803/EnM.2023.1816

Abstract

Type 2 diabetes (T2D) is a progressive disease in which it is challenging to achieve long-term durable glycemic control. However, intensive glycemic control is crucial for preventing diabetes-related complications. Previous studies showed that monotherapy with a stepwise add-on approach was seldom effective for long-term durable glycemic control. Combination therapy, which refers to the use of two or more drugs to control hyperglycemia, has multiple benefits, including the ability to target a variety of pathophysiological processes underlying hyperglycemia. In clinical trials, initial combination therapy showed better glycemic control than monotherapy or a stepwise approach. Emerging evidence indicates that initial combination therapy is associated with preserved β-cell function and fewer complications in T2D. However, cost-effectiveness and adverse events with combination therapy are issues that should be considered. Therefore, initial combination therapy is an important option for patients with T2D that clinicians should consider with a view toward balancing benefits and potential harms. In this review, we summarize the literature addressing initial combination therapy in T2D, and we suggest optimal strategies based on clinical situations and patient characteristics.

Keyword

Diabetes mellitus, type 2; Drug therapy, combination; Glycemic control; Hypoglycemic agents

Figure

• 

  Fig. 1. Suggestions for initial combination therapy. HbA1c, glycated hemoglobin; BMI, body mass index; MET, metformin; DPP4i, dipeptidylpeptidase-4 inhibitor; TZD, thiazolidinedione; SGLT2i, sodium-glucose cotransporter 2 inhibitor; SU, sulfonylurea; GLP-1RA, glucagon-like peptide 1 receptor agonist.

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