New-Onset Diabetes Benefits from Initial Triple Combination

Initial combination therapy of metformin, pioglitazone, and exenatide might be more effective in reducing HbA1c compared to sequential add-on in new-onset diabetic patients…

The purpose of this study is to initiate a therapy regimen that will reduce HbA1c, increase insulin secretion, and increase insulin sensitivity. This therapy will also avoid side effects such as hypoglycemia, and weight gain, and will target new-onset diabetes individuals.

Drug-naïve, recently diagnosed type 2 diabetics were selected randomly to be on a diabetes regimen consisting of metformin/pioglitazone/exenatide (n=106) or metformin, sulfonylurea, and glargine insulin (n=115). They had to maintain an HbA1c level of <6.5% for 2 years.

Individuals who were on the metformin/pioglitazone/exenatide had significantly greater HbA1c level reduction (p<0.001). Hypoglycemia was 7.5-fold less frequent, and mean weight loss was 1.2 kg vs 4.1 kg weight gain compared to the conventional therapy.

New-onset diabetes patient who are on the metformin/pioglitazone/exenatide regimen had better outcomes of HbA1c, hypoglycemia, and weight loss compared to the traditional sequential therapy of metformin followed by sulfonylurea and insulin.

Practice Pearls:

• Initial combination therapy of metformin, pioglitazone, and exenatide is more effective in reducing HbA1c compared to traditional sequential therapy of metformin, sulfonylurea, and insulin.
• Individuals who were on the metformin/pioglitazone/exenatide had significantly greater HbA1c level reduction.
• Less hypoglycemia and weight loss are experienced with this new therapy.

M. A. Abdul-Ghani, C. Puckett, C. Triplitt, D. Maggs, J. Adams, E. Cersosimo, and R. A DeFronzo. “Initial combination therapy with metformin, pioglitazone and exenatide is more effective than sequential add-on therapy in subjects with new-onset diabetes. Results from the Efficacy and Durability of Initial Combination Therapy for Type 2 Diabetes (EDICT): a randomized trial.” Diabetes, Obesity and Metabolism. 7 Jan 2015;17(3):268-275.