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For patients with type 2 diabetes mellitus, management of hyperglycemia is typically complex, and few patients successfully achieve and maintain recommended targets for glycated hemoglobin (HbA1c). Increasingly, combination therapy is recommended early in the disease course, or even directly at diagnosis in patients with relatively high HbA1c levels. A recent randomized, placebo-controlled, Phase III trial investigated the initial combination of linagliptin and metformin in patients with inadequate glycemic control to assess the benefits of initial combination compared with monotherapy. Linagliptin and metformin act in complementary ways, and the combination treatment showed superior efficacy compared with either monotherapy. Notably, responses were largest in patients with higher baseline HbA1c levels compared with moderate levels, suggesting this combination could be considered in these patients. This may be particularly relevant for those unwilling to start insulin because they prefer oral therapy or need to avoid body weight gain. Neither metformin nor linagliptin is associated with weight gain, and in this trial the combination was also weight neutral. As this combination therapy was well tolerated, with a low frequency of hypoglycemia, these findings suggest that initial combination of linagliptin plus metformin may have advantages for a large proportion of patients in clinical practice.

Keywords: biguanides, diabetes mellitus, dipeptidyl peptidase-IV inhibitors, drug therapy, combination, hyperglycemia, incretins, linagliptin, metformin

Citation: Freeman, JS. Initial combination therapy for patients with type 2 diabetes mellitus: considerations for metformin plus linagliptin. Drugs in Context 2013;212256. doi: 10.7573/dic.212256

Provenance: Submitted; externally peer reviewed

Dates: Submitted: 30 May 2013; Accepted, subject to peer review: 31 May 2013; Published: 21 August 2013

Copyright: © 2013 Freeman, JS. This is an open-access article distributed under the terms of the Creative Commons Attribution License Deed CC BY NC ND 3.0 which allows anyone to copy, distribute and transmit the article provided it is properly attributed in the manner specified below. No other uses without permission.

Correct attribution: Copyright © 2013 Freeman, JS. http://dx.doi.org/10.7573/dic.212256. Published by Drugs in Context under Creative Commons Attribution License Deed CC BY NC ND 3.0.

Correspondence: Jeffrey S Freeman DO, Division of Endocrinology and Metabolism, Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19131-1633, USA

Email: jeffreyfreemando@aol.com