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