Role of Combination Therapy with SGLT2 Inhibitor with Metformin as Initial Treatment for Type2 Diabetes-Advantages of Oral Fixed Drug Pill Like Empagliflozin/Metformin in Patients with Cardiovascular and Renal Risk-A Short Communication

The incidence of Type 2 Diabetes is increasing worldwide, associated with obesity, so much so that the term diabesity got coined. Not only is the incidence increasing but both morbidity and mortality are increasing worldwide. Thus it is empirical to treat T2DM efficiently so that the cardiovascular (CV) and renal problems get taken care of. All the ADA/AACE/ACE recommend treating with a combination therapy in patients having a high Hb A1c. The preferred drugs has been the initial metformin and recent multiple trials and studies have shown the superiority of the sodium glucose cotransporter 2(SGLT2) inhibitor of which empagliflozin along with metformin has been tried in fixed dose combination, whose advantages are not only that they take care of T2DM but have simultaneous weight reducing, blood pressure reducing, increased compliance along with individualization of therapy for the patients having a risk of major adverse CV event as tested by the EMPA-REG-OUTCOME in 7020 patients along with further corroborated with more studies. Thus simultaneous control ofT2DM, BP, weight, CV outcomes and renal effects makes a combination of empagliflozin 10 or 25mg in combination with metformin, both having complementary roles and need to be the initial treatment of choice in a fixed dose pill ,making it easier for the patient to need just one tablet. In 2016 FDA has also recommended the use of this for this group of patients having major risk of CV events.

Keywords: T2DM; SGLT2 Inhibitors; metformin; empagliflozin; FDA; CV event.