Rational combination therapy for type 2 diabetes

Type 2 diabetes is a progressive disease that requires intensified treatment to ensure sustained glycaemic control. Such intensification is generally achieved by combining two or more glucose lowering agents. Although this treatment is intuitive (ie, two is better than one), how to select combination agents is less apparent. With the current availability of eight classes of glucose-lowering medications, there are 28 possible dual combinations and 56 triple combinations. 1 Bianchi C Daniele G Dardano A Miccoli R Del Prato S Early combination therapy with oral glucose-lowering agents in type 2 diabetes. Drugs. 2017; 77: 247-264 Crossref PubMed Scopus (24) Google Scholar One way to approach such a difficult decision is to evaluate to what extent a combination therapy meets several predefined criteria, such as addressing the pathophysiological mechanisms underlying the disease, to what extent these mechanisms are complementary, overall efficacy and safety, and whether a given combination could provide advantages beyond the effect on glucose control. These criteria can be used to consider the results of SUSTAIN 9, a randomised trial by Bernard Zinman and colleagues 2 Zinman B Bhosekar V Busch R et al. Semaglutide once-weekly as add-on to SGLT-2 inhibitor therapy in type 2 diabetes (SUSTAIN 9): a randomised, placebo-controlled trial. Lancet Diabetes Endocrinol. 2019; (published online March 1.)http://dx.doi.org/10.1016/S2213-8587(19)30066-X Summary Full Text Full Text PDF PubMed Scopus (140) Google Scholar published in The Lancet Diabetes & Endocrinology. This placebo-controlled trial explored the effect of semaglutide (once weekly) as an add-on to sodium-glucose co-transporter-2 (SGLT-2) inhibitor therapy in patients with type 2 diabetes. Semaglutide once weekly as add-on to SGLT-2 inhibitor therapy in type 2 diabetes (SUSTAIN 9): a randomised, placebo-controlled trialAdding semaglutide to SGLT-2 inhibitor therapy significantly improves glycaemic control and reduces bodyweight in patients with inadequately controlled type 2 diabetes, and is generally well tolerated. Full-Text PDF