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Early combination therapy delayed treatment escalation in newly diagnosed young‐onset type 2 diabetes: A subanalysis of the VERIFY study
Author(s) -
Chan Juliana C. N.,
Paldánius Päivi M.,
Mathieu Chantal,
Stumvoll Michael,
Matthews David R.,
Del Prato Stefano
Publication year - 2021
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.14192
Subject(s) - medicine , type 2 diabetes , metformin , vildagliptin , combination therapy , clinical endpoint , diabetes mellitus , randomization , gastroenterology , randomized controlled trial , endocrinology , insulin
We analysed glycaemic durability (sustained glycaemic control) with early combination therapy (metformin plus vildagliptin) versus metformin monotherapy, among patients with type 2 diabetes diagnosed before (young‐onset [YOD]) and after (late‐onset [LOD]) the age of 40 years, enrolled in the VERIFY trial. The primary endpoint was time to initial treatment failure (TF), defined as HbA1c of 7.0% or higher at two consecutive scheduled visits after randomization. The time to secondary TF was assessed when both groups were receiving and failing on the combination. A total of 186 (9.3%) patients had YOD and 1815 (90.7%) had LOD with a mean age difference of 20.4 years. Compared with metformin monotherapy, early combination reduced the risk of time to initial TF for both YOD (48%, P < .0006) and LOD (46%, P < .0001). With early combination, risk for time to secondary TF was reduced by 48% ( P < .0035) in YOD and 24% ( P < .0009) in LOD. Both treatment approaches were well tolerated with no unexpected safety concerns. In treatment‐naïve patients with YOD (HbA1c 6.5%‐7.5%), an early combination strategy improved attainment of the glycaemic target with durability and delayed treatment escalation compared with initial metformin monotherapy.