Two drugs are better than one to start T2DM therapy

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Early and intensive glycaemic control protects patients with type 2 diabetes mellitus (T2DM) from the development of late cardiovascular complications. The authors of the VERIFY trial now show that a more durable attainment of HbA1c <7% is observed by adding vildagliptin to metformin as starting therapy in newly diagnosed patients with T2DM.

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Fig. 1: Proposal for merging the glucocentric and the cardiocentric view of T2DM treatment.


  1. 1.

    [No authors listed.] Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 352, 837–853 (1998).

  2. 2.

    Holman, R. R. et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N. Engl. J. Med. 359, 1577–1589 (2008).

  3. 3.

    Laiteerapong, N. et al. The legacy effect in type 2 diabetes: impact of early glycemic control on future complications (The Diabetes & Aging Study). Diabetes Care 42, 416–426 (2019).

  4. 4.

    Brown, J. B., Conner, C. & Nichols, G. A. Secondary failure of metformin monotherapy in clinical practice. Diabetes Care 33, 501–506 (2010).

  5. 5.

    Phung, O. J. et al. Early combination therapy for the treatment of type 2 diabetes mellitus: systematic review and meta-analysis. Diabetes Obes. Metab. 16, 410–417 (2014).

  6. 6.

    Matthews, D. R. et al. 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 394, 1519–1529 (2019).

  7. 7.

    Schnell, O. et al. Report from the 4th Cardiovascular Outcome Trial (CVOT) Summit of the Diabetes & Cardiovascular Disease (D&CVD) EASD Study Group. Cardiovasc. Diabetol. 18, 30 (2019).

  8. 8.

    Davies, M. J. et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 41, 2669–2701 (2018).

  9. 9.

    Cosentino, F. et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur. Heart J. https://doi.org/10.1093/eurheartj/ehz486 (2019).

  10. 10.

    Abdul-Ghani, M. & DeFronzo, R. A. Is it time to change the type 2 diabetes treatment paradigm? Yes! GLP-1 RAs should replace metformin in the type 2 diabetes algorithm. Diabetes Care 40, 1121–1127 (2017).

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The authors thank the Italian Ministry of Health (Ricerca Corrente), who supported part of this work.

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Correspondence to Antonio Ceriello.

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Prattichizzo, F., La Sala, L. & Ceriello, A. Two drugs are better than one to start T2DM therapy. Nat Rev Endocrinol (2019) doi:10.1038/s41574-019-0294-3

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