Early combination versus initial metformin monotherapy in th
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Type 2 diabetes mellitus (T2DM) in East Asian population is characterized by phenotypes such as low body mass index, an index of Beta cell dysfunction, and higher percentage of body fat, an index of insulin resistance. These phenotypes/pathologies may predispose people to early onset of diabetes with increased risk of stroke and renal disease.

Less than 50% of patients with T2DM in East Asia achieve glycemic targets recommended by national or regional guidelines, which may be due to knowledge and/or implementation gaps.

This article reviews the latest evidence with special reference to East Asian patients with T2DM and present arguments for the need to use early combination therapy to intensify glycemic control. This strategy is supported by the 5-year worldwide VERIFY study, which has reported better glycemic durability in newly diagnosed patients with T2DM with a mean HbA1c of 6.9% treated with early combination therapy of vildagliptin plus metformin versus those treated with initial metformin monotherapy followed by addition of vildagliptin only with worsening glycemic control.

This paradigm shift of early intensified treatment is now recommended by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).

In order to translate these evidence to practice, increased awareness and strengthening of the healthcare system are needed to diagnose and manage patients with T2DM early for combination therapy.

Source: https://dom-pubs.onlinelibrary.wiley.com/doi/abs/10.1111/dom.14205?af=R
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