ADA 2018 — Metformin triple combo does well in EDICT 6-year follow-up


  • W. Todd Penberthy, Ph.D.
  • Conference Reports
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Takeaway

  • EDICT 6-year data support first-line (1L) use of a triple combination (metformin, sulfonylurea, and basal insulin) for newly diagnosed type 2 diabetes (T2D).
  • Data show greater and more sustained reductions in A1C with combination therapy vs the traditional sequential add-on approach.

Why this matters

  • Hyperglycemia is the major factor responsible for microvascular complications, and every 1% decrease in glycated hemoglobin (HbA1c) level is associated with a ~35% decrease in the risk for microvascular complications, but hypoglycemia is also associated with increased mortality risk. 
  • Importantly, both the thiazolidinediones and glucagon-like peptide-1 (GLP-1) analogs used in triple therapy lower HbA1c levels without increasing hypoglycemia risk and improve beta cell function. In contrast, the conventional second-line sulfonylureas provide no protective benefit to beta cells. 

Study design

  • Patients with new-onset T2D were randomly assigned to receive triple therapy (metformin, pioglitazone, and exenatide; n=132) or an escalating dose of metformin followed by sequential addition of glipizide and then glargine insulin (conventional therapy; n=146) to maintain A1C

Key results

  • Triple therapy resulted in a greater reduction in A1C after a mean follow-up of 6 years vs conventional therapy (5.8% vs 6.7%; P<.001 class=""> 
  • More subjects maintained HbA1c  

Limitations

  • Single-center study primarily of Mexican-American origin. 
  • Relatively high drop-out rate, but similar to previous studies. 

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