Antidiabetic Combination Therapy for Type 2 Diabetes

Janet B. McGill, MD


September 24, 2021

Clinicians treating patients with type 2 diabetes (T2D) understand it to be a complex disease with many comorbidities. Treatment, therefore, should extend beyond simply lowering a patient's A1c level. Combining newer agents such as GLP-1 receptor agonists and SGLT2 inhibitors with metformin or insulin regimens should be introduced early to address patients' specific risks and comorbidities, says Dr Janet McGill of Washington University in St. Louis.

The majority of T2D patients are initially treated on monotherapy with metformin, but that may fail to address comorbidities such as obesity, fatty liver disease, cardiovascular disease, or kidney dysfunction. Disease-modifying therapies such as GLP-1 receptor agonists or SGLT2 inhibitors can help. Although achieving target glycemic control is essential, Dr McGill says it should not be the only goal. Combination therapy can help avoid end-stage kidney and heart disease.

For patients on insulin regimens, combination therapy is equally applicable. Several major cardiovascular outcome trials that included patients on insulin indicated that these patients benefited from the addition of these newer agents.

Dr McGill closes by discussing the new agent tirzepatide, a dual GIP and GLP-1 receptor agonist that has been shown to lower A1c and effectively reduce body weight and liver fat. She anticipates that this agent will be a welcome addition to the T2D armamentarium.


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