Is Dual Add-On Therapy Better for T2DM When Metformin Isn't Enough?

the MPR take:

Is triple therapy with saxagliptin plus dapagliflozin added on in patients with type 2 diabetes poorly controlled with metformin more effective than dual therapy with saxagliptin or dapagliflozin plus metformin? In a double-blind trial, adults with HbA1c ≥8.0% and ≤12.0% (64–108mmol/mol) were randomized to saxagliptin 5mg/day plus dapagliflozin 10mg/day; n = 179), saxagliptin 5mg/day and placebo, or dapagliflozin 10mg/day and placebo on background metformin extended release ≥1,500mg/day. At week 24, patients in the triple therapy arm had -1.5% mean change in HbA1c from baseline vs. -0.9% for saxagliptin and -1.2% for dapagliflozin. Forty-one percent of patients in the triple therapy arm achieved HbA1c <7% (53mmol/mol), 18% in the saxagliptin group, and 22% in the dapagliflozin group. No episodes of major hypoglycemia were reported and hypoglycemia overall was infrequent. For patients with type 2 diabetes that is poorly controlled by metformin alone, this well-tolerated combination of saxagliptin plus dapagliflozin with metformin may be more effective in achieving optimal HbA1c levels.

OBJECTIVE: This study compared the efficacy and safety of dual add-on of saxagliptin plus dapagliflozin versus saxagliptin and dapagliflozin added on alone in patients with type 2 diabetes poorly controlled with metformin. RESEARCH DESIGN AND METHODS: This was a double-blind trial in adults with ...

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