Early combination versus initial metformin monotherapy in the management of newly diagnosed type 2 diabetes: AnEast Asianperspective

Abstract

Type 2 diabetes (T2D) in the East Asian population is characterized by phenotypes such as low body mass index, an index of β‐cell dysfunction, and higher percentage of body fat, an index of insulin resistance. These phenotypes/pathologies may predispose people to early onset of diabetes with increased risk of stroke and renal disease. Less than 50% of patients with T2D in East Asia achieve glycaemic targets recommended by national or regional guidelines, which may be attributable to knowledge and/or implementation gaps. Herein, we review the latest evidence with special reference to East Asian patients with T2D and present arguments for the need to use early combination therapy to intensify glycaemic control. This strategy is supported by the 5‐year worldwide VERIFY study, which reported better glycaemic durability in newly diagnosed patients with T2D with a mean HbA1c of 6.9% treated with early combination therapy of vildagliptin plus metformin versus those treated with initial metformin monotherapy followed by addition of vildagliptin only with worsening glycaemic control. This paradigm shift of early intensified treatment is now recommended by the American Diabetes Association and the European Association for the Study of Diabetes. In order to translate these evidence to practice, increased awareness and strengthening of the healthcare system are needed to diagnose and manage patients with T2D early for combination therapy.

Epidemiology of Diabetes and Atherosclerotic Cardiovascular Disease Among Asian American Adults: Implications, Management, and Future Directions: A Scientific Statement From the American Heart Association

“…138,[147][148][149] However, Asian adults may also benefit from the newer medications in place of metformin monotherapy or in combination with metformin. [150][151][152] According to the 2022 ADA standard of care, 153,154 newer classes of drugs such as sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, and the nonsteroidal, selective mineralocorticoid receptor antagonist finerenone [155][156][157][158][159][160] provide several additional beneficial metabolic actions and cardiorenal protective effects. These medications are encouraging as a potential therapeutic choice in AsA adults because these medication classes are insulin independent and their use is likely not associated with hypoglycemia risk, a side effect that is common among the AsA population.…”

The comparison of the antidiabetic effects of exenatide, empagliflozin, quercetin, and combination of the drugs in type 2 diabetic rats

“…Exercise, diet programs, and monotherapy treatment in early T2DM are important [6,7]. However, T2DM may worsen due to the complex pathophysiology of T2DM and poor glycemic control in patients treated with monotherapy [6,8]. The combination of different classes of antidiabetic drugs provides synergistic effects on glycemic control with different mechanisms [8,9].…”

“…However, T2DM may worsen due to the complex pathophysiology of T2DM and poor glycemic control in patients treated with monotherapy [6,8]. The combination of different classes of antidiabetic drugs provides synergistic effects on glycemic control with different mechanisms [8,9]. In addition, herbal medicines contribute the antidiabetic effectiveness and the patients prefer them easily because they are low-cost and suitable for daily use [10].…”

Improving beta‐cell secretory function and glycaemia in young‐onset type 2 diabetes: A pilot, 12‐month, randomized trial of a novel, continuous glucose monitor‐guided, rapid treatment intensification strategy incorporating empagliflozin and liraglutide

“…Interestingly, there is an increasing body of evidence suggesting that glucagon‐like peptide‐1 receptor agonist and sodium‐glucose cotransporter 2 inhibitors may protect or even augment β‐cell function 6‐8 . In addition, the clinical efficacy of early combination therapy in YT2D with respect to the improvement in durability of glycaemic control is increasingly being recognized 9,10 . Here we report key feasibility, glycaemic and β‐cell secretory outcomes of a 12‐month pilot study exploring a novel, continuous glucose monitor (CGM)‐guided, rapid treatment intensification (RTI) strategy to achieve early stringent glycaemic control, with the stepped use of empagliflozin and add‐on liraglutide in young adults with recently diagnosed T2D.…”

“…[6][7][8] In addition, the clinical efficacy of early combination therapy in YT2D with respect to the improvement in durability of glycaemic control is increasingly being recognized. 9,10 Here we report key feasibility, glycaemic and β-cell secretory outcomes of a 12-month pilot study exploring a novel, continuous glucose monitor (CGM)-guided, rapid treatment intensification (RTI) strategy to achieve early stringent glycaemic control, with the stepped use of empagliflozin and add-on liraglutide in young adults with recently diagnosed T2D. Following recruitment, individuals were assigned (1:1) to RTI and SOC groups on the basis of minimization considering gender, age, HbA1c, estimated glomerular filtration rate, urine albumin-tocreatinine ratio and body mass index at baseline.…”