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Posted by on Jul 16, 2019 in Diabetes mellitus | 0 comments

In a nutshell

This article investigated the safety and effectiveness of triple therapy with low dose dapagliflozin (Farxiga) plus saxagliptin (Onglyza) added to metformin (Glucophage) in uncontrolled type 2 diabetes (T2D). The authors concluded that triple therapy significantly improved blood glucose control in these patients.

Some background

T2D is a disorder where the body can no longer use insulin correctly. This results in high blood glucose (BG). This high BG can cause many side effects for the patients if not managed correctly. The current treatment involves starting patients on metformin and then seeing how they respond to it. Then adding in other blood-glucose-lowering drugs as time goes on if metformin alone did not work. However, for some patients, blood glucose control may still be poor with this treatment plan.

An alternative is to start the patient on both metformin and another glucose-lowering drug straight away (dual therapy) or metformin and two glucose-lowering drugs (triple therapy). It is not known if this is a safer or more efficient option in patients with uncontrolled T2D. 

Methods & findings

The study involved 883 patients with T2D. There were 3 groups. Group 1 (triple therapy) were treated with metformin, dapagliflozin and saxagliptin. Group 2 (dual therapy) were given metformin and dapagliflozin. Group 3 (dual therapy) were given metformin and saxagliptin. Patients were followed up at 24 weeks, and their HbA1c (measure of long-term blood glucose control) levels were measured.

After 24 weeks, HbA1c levels had decreased more in group 1 (by 1.03%) compared with group 2 (by 0,63%) and with group 3 (by 0.69%). Overall HbA1c levels were kept below 7% in 41.6% of patients in group 1, 21.8% in group 2 and 29.8% in group 3.

The level of blood glucose while fasting was decreased in group 1 by 28 mg, by 20 mg in group 2 and by 13 mg in group 3. Bodyweight was also decreased more in group 1 (by 2 kg) compared with group 3 (by 0.4 kg).

Side effects were similarly reported in all groups.

The bottom line

The authors concluded that triple therapy with metformin, dapagliflozin, and saxagliptin is more effective for patients with uncontrolled T2D compared to dual therapy. 

The fine print

This study was relatively short (24 weeks) so longer studies would be needed to confirm the findings.

What’s next?

If you have concerns regarding T2D therapy, please discuss this with your doctor.

Published By :

Diabetes, Obesity and Metabolism

Date :

May 30, 2019

Original Title :

Triple Therapy With Low-Dose Dapagliflozin Plus Saxagliptin Versus Dual Therapy With Each Monocomponent, All Added to Metformin, in Uncontrolled Type 2 Diabetes.

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