Advertisement

Combination therapy as a first step of treatment in diabetes: Changing the paradigm in KDIGO guidelines?

  • Nicolás Roberto Robles
    Correspondence
    Corresponding author at: Unidad de Hipertensión Arterial, Servicio de Nefrología, Hospital Universitario de Badajoz, Universidad de Extremadura, Carretera de Portugal s/n. 06070, Badajoz, Spain.
    Affiliations
    Unidad de Hipertensión Arterial, Servicio de Nefrología, Hospital Universitario de Badajoz, Universidad de Extremadura, Carretera de Portugal s/n. 06070, Badajoz, Spain

    Cardiovascular Risk Chair, University of Salamanca School of Medicine, Salamanca, Spain
    Search for articles by this author
  • Alvaro Alvarez
    Affiliations
    Unidad de Hipertensión Arterial, Servicio de Nefrología, Hospital Universitario de Badajoz, Universidad de Extremadura, Carretera de Portugal s/n. 06070, Badajoz, Spain
    Search for articles by this author
  • Francesco Fici
    Affiliations
    Cardiovascular Risk Chair, University of Salamanca School of Medicine, Salamanca, Spain
    Search for articles by this author
Published:March 15, 2023DOI:https://doi.org/10.1016/j.ejim.2023.02.024

      Highlights

      • New KDIGO guidelines for diabetes mellitus treatment in chronic kidney disease suggest to early start treatment with a drug combination (metformin plus SGLT2i).
      • Although there is no available on the use of this combination from the beginning there is enough background of safety and efficacy to support this use.
      • This is an important, although expected, change in the current recommendations of type 2 diabetes mellitus treatment. Nevertheless, it is restricted to chronic kidney disease patients.

      Keywords

      Abbreviations:

      KDIGO (Kidney Disease Improving Global Outcomes)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Whelton P.K.
        • Committee W.
        • Carey R.M.
        • et al.
        2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults.
        J Am Coll Cardiol. 2017; 2017: 735-1097
        • Williams B.
        • Mancia G.
        • Desormais I.
        • et al.
        2018 ESC/ESH guidelines for the management of arterial hypertension.
        Eur Heart J. 2018; 39: 3021-3104
        • Nerenberg K.A.
        • Zarnke K.B.
        • Leung A.A.
        • et al.
        Hypertension Canada's 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children.
        Can J Cardiol. 2018; 34: 506-525
        • Task Force of the Latin American Society of Hypertension
        Guidelines on the management of arterial hypertension and related comorbidities in Latin America.
        J Hypertens. 2017; 35: 1529-1545
      1. National Clinical Guideline Centre (UK). Hypertension: clinical management of primary hypertension in adults (NICE Clinical Guideline 127). https://www.ncbi.nlm.nih.gov/books/NBK83274/. Accessed.

        • Jamerson K.
        • Weber M.A.
        • Bakris G.L.
        • et al.
        Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients.
        N Engl J Med. 2008; 359: 2417-2428
        • American Diabetes Association Professional Practice Committee
        Pharmacologic approaches to glycemic treatment: standards of medical care in diabetes-2022.
        Diabetes Care. 2022; 45 (1 January): S125-S143
        • Abdul-Ghani M.A.
        • Puckett C.
        • Triplitt C.
        • et al.
        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 Obes Metab. 2015; 17: 268-275
        • Phung O.J.
        • Sobieraj D.M.
        • Engel S.S.
        • Rajpathak S.N.
        Early combination therapy for the treatment of type 2 diabetes mellitus: systematic review and meta-analysis.
        Diabetes Obes Metab. 2014; 16: 410-417
        • Matthews D.R.
        • Paldánius P.M.
        • Proot P.
        • Chiang Y.
        • Stumvoll M.
        • VERIFY study group
        Glycaemic durability of an early combination therapy with vildagliptin and metformin versus sequential metformin monotherapy in newly diagnosed type 2 diabetes (VERIFY): a 5-year, multicentre, randomised, double-blind trial.
        Lancet. 2019; 394: 1519-1529
        • de Boer I.H.
        • Khunti K.
        • Sadusky T.
        • Tuttle K.R.
        • Neumiller J.J.
        • Rhee C.M.
        • Rosas S.E.
        • Rossing P.
        • Bakris G.
        Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO).
        Diabetes Care. 2022; (dci220027)https://doi.org/10.2337/dci22-0027
        • Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group
        KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease.
        Kidney Int. 2022; 102: S1-S127
        • Matthews D.R.
        • Paldánius P.M.
        • Proot P.
        • Chiang Y.
        • Stumvoll M.
        • Del Prato S.
        • VERIFY study group
        Glycaemic durability of an early combination therapy with vildagliptin and metformin versus sequential metformin monotherapy in newly diagnosed type 2 diabetes (VERIFY): a 5-year, multicentre, randomised, double-blind trial.
        Lancet. 2019; 394: 1519-1529
        • Henry R.R.
        • Murray A.V.
        • Marmolejo M.H.
        • Hennicken D.
        • Ptaszynska A.
        • List J.F.
        Dapagliflozin, metformin XR, or both: initial pharmacotherapy for type 2 diabetes, a randomised controlled trial.
        Int J Clin Pract. 2012; 66: 446-456
        • Phung O.J.
        • Sobieraj D.M.
        • Engel S.S.
        • Rajpathak S.N.
        Early combination therapy for the treatment of type 2 diabetes mellitus: systematic review and meta-analysis.
        Diabetes Obes Metab. 2014; 16: 410-417
        • Scheen A.J.
        SGLT2 inhibitors as add-on therapy to metformin for people with type 2 diabetes: a review of placebo-controlled trials in Asian versus Non-Asian Patients.
        Diabetes Metab Syndr Obes. 2020; 13 (Aug 5): 2765-2779
        • Scheen A.J.
        Pharmacokinetic/pharmacodynamic properties and clinical use of SGLT2 inhibitors in non-Asian and Asian patients with type 2 diabetes and chronic kidney disease.
        Clin Pharmacokinet. 2020; https://doi.org/10.1007/s40262-40020-00885-z
        • Cai X.
        • Gao X.
        • Yang W.
        • et al.
        No disparity of the efficacy and all-cause mortality between Asian and non-Asian type 2 diabetes patients with sodium-glucose cotransporter 2 inhibitors treatment: a meta-analysis.
        J Diabetes Investig. 2018; 9: 850-861
        • Abushanab D.
        • Liew D.
        • Marquina C.
        • Al-Badriyeh D.
        • Ademi Z.
        Cost-effectiveness of empagliflozin and metformin combination versus standard care as first-line therapy in patients with type 2 diabetes mellitus.
        Endocr Pract. 2022; 28: 16-24
        • Schnell O.
        • Standl E.
        • Catrinoiu D.
        • et al.
        Report from the 4th Cardiovascular Outcome Trial (CVOT) summit of the Diabetes & Cardiovascular Disease (D&CVD) EASD study group.
        Cardiovasc Diabetol. 2019; 18: 30https://doi.org/10.1186/s12933-019-0822-4