Academic Journal
Early combination therapy in type 2 diabetes: Rethinking initial treatment strategies.
| Τίτλος: | Early combination therapy in type 2 diabetes: Rethinking initial treatment strategies. |
|---|---|
| Συγγραφείς: | Janez A; Department of Endocrinology, Diabetes and Metabolic Diseases, Division of Internal Medicine, University Medical Centre Ljubljana, Slovenia. Electronic address: andrej.janez@kclj.si., Smid T; Department of Endocrinology, Diabetes and Metabolic Diseases, Division of Internal Medicine, University Medical Centre Ljubljana, Slovenia., Rizzo M; School of Medicine, Department of Health Promotion, Mother and Childcare, Internal Medicine and Medical Specialties, University of Palermo, Italy., Tankova T; Department of Endocrinology, Medical University of Sofia, Bulgaria. |
| Πηγή: | Journal of diabetes and its complications [J Diabetes Complications] 2026 Oct; Vol. 40 (10), pp. 109392. Date of Electronic Publication: 2026 Aug 14. |
| Τύπος έκδοσης: | Journal Article; Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Science Pub. Co Country of Publication: United States NLM ID: 9204583 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-460X (Electronic) Linking ISSN: 10568727 NLM ISO Abbreviation: J Diabetes Complications Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: New York, NY : Elsevier Science Pub. Co., c1992- |
| Ιατρικοί όροι (MeSH): | Diabetes Mellitus, Type 2*/drug therapy , Diabetes Mellitus, Type 2*/blood , Diabetes Mellitus, Type 2*/complications , Hypoglycemic Agents*/therapeutic use , Hypoglycemic Agents*/administration & dosage , Glycemic Control*/methods , Glycemic Control*/standards , Early Medical Intervention*/methods , Early Medical Intervention*/standards, Drug Therapy, Combination/methods ; Humans ; Metformin ; Practice Guidelines as Topic |
| Περίληψη: | For decades, type 2 diabetes (T2D) pharmacotherapy has followed a reactive, stepwise approach, typically initiated with metformin monotherapy and intensified only after glycemic deterioration. This so-called wait-to-fail strategy may prolong hyperglycemia and increase the cumulative risk of microvascular and macrovascular complications. Early combination therapy (ECT) has been proposed as an alternative strategy to achieve faster glycemic control, improve glycemic durability, and enable timely use of glucose-lowering agents with cardiovascular, renal, and metabolic benefits. This narrative review examines the rationale for ECT in newly diagnosed T2D and summarizes evidence from landmark clinical trials. Recent updates to major international guidelines, including the 2026 American Diabetes Association Standards of Care in Diabetes and National Institute for Health and Care Excellence NG28, are also discussed, reflecting a shift toward individualized, comorbidity-focused treatment selection. While ECT represents an important evolution in T2D management, current clinical evidence supports its use mainly in selected patients rather than as a universal default strategy. (Copyright © 2026 Elsevier Inc. All rights reserved.) |
| Competing Interests: | Declaration of competing interest Tanja Smid declares no conflict of interest. Andrej Janez has served as a consultant and is on Speakers Bureaus for AstraZeneca, Boehringer Ingelheim, Eli Lilly, Medtronic, Abbott, NovoNordisk, Sibionics. Manfredi Rizzo currently serves as the Editor-in-Chief of the Journal of Diabetes and Its Complications. Given his role, Manfredi Rizzo had no involvement in the peer review of this article and had no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to another journal editor. Manfredi Rizzo has given lectures, received honoraria and research support and participated in conferences, advisory boards and clinical trials sponsored by many pharmaceutical companies, including Amgen, AstraZeneca, Biodexa, Boehringer Ingelheim, Kowa, Eli Lilly, Meda, Mylan, Merck Sharp & Dohme, Novo Nordisk, Novartis, Roche, Sanofi and Servier. Tsvetalina Tankova has received payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing or educational events from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Sanofi, Servier, Merck, MSD, Worwag. |
| Contributed Indexing: | Keywords: Cardiovascular-kidney-metabolic risk; Early combination therapy; GLP-1 receptor agonists; Glycemic control; Glycemic durability; SGLT2 inhibitors; Type 2 diabetes |
| Substance Nomenclature: | 0 (Hypoglycemic Agents) 9100L32L2N (Metformin) |
| Entry Date(s): | Date Created: 20260825 Date Completed: 20260907 Latest Revision: 20261009 |
| Update Code: | 20261010 |
| DOI: | 10.1016/j.jdiacomp.2026.109392 |
| PMID: | 42641257 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1873-460X |
|---|---|
| DOI: | 10.1016/j.jdiacomp.2026.109392 |