Triple-drug success foreshadows T2DM combo pill

Reducing tablet counts for patients is a way to move forward in managing type 2 diabetes. We already have formulations that combine two oral hypoglycemic drugs, and developing a single pill that combines three drugs seems like a logical next step. But the logistics of this are not simple. I have concerns about drug tolerability, and we need a much better understanding of the potential complementary effects of simultaneous treatment with metformin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, and a dipeptidyl peptidase-4 (DPP-4) inhibitor. In addition, in some patients, moving from treatment with a single drug to treatment with three drugs may be too great a leap. Sequential progression from one to two and then a third drug if still needed may be best for some patients.

Dr. Melanie Davies

Combination of metformin, an SGLT2 inhibitor, and a DPP-4 inhibitor has been suggested by many diabetologists as an attractive option, and I agree it has promise. These drugs are reasonably well tolerated and have good effects on hemoglobin A_1c as well as blood pressure and weight loss, with a low risk of causing hypoglycemia.

Dr. Melanie J. Davies is professor of diabetes medicine at the University of Leicester, England. She has been a consultant to and speaker for Boehringer Ingelheim and several other drug companies. She made these comments in an interview.