Research
Hormonal
If initial double combination therapy fails to control HbA1c, a triple combination of metformin, SGLT-2 inhibitor, and GLP-1 receptor agonist is recommended as the best treatment to reduce cardiovascular events and mortality.
If your first two medications don't control your blood sugar, add a third: a combination of metformin, an SGLT-2 inhibitor, and a GLP-1 receptor agonist. This is the most effective way to protect your heart and kidneys based on current real-world evidence.
GoodSupportsHIGH confidence
In persons with type 2 diabetes, if the initial double combination is not sufficient, a triple combination (SGLT-2 inhibitor, GLP-1 receptor agonist, and metformin) is recommended.
Why this rating
Based on real-world experience and observational data, as official CVOTs for the triple combo are not yet complete.
Source
Swiss recommendations of the Society for Endocrinology and Diabetes (SGED/SSED) for the treatment of type 2 diabetes mellitus (2023)
Giacomo Gastaldi et al. · Swiss Medical Weekly · 2023
DOI 10.57187/smw.2023.40060
clinical_guidelineCited 29×
Read the paper DOI resolved against Crossref · corpus check 2026-06-10
More from this paper
- Initial treatment for type 2 diabetes should be a combination of metformin and either an SGLT-2 inhibitor or a GLP-1 receptor agonist to achieve cardiorenal protection, rather than monotherapy or older agents like sulfonylureas.Strong
- Insulin should be the first-line treatment if insulin deficiency is the predominant factor at the onset of type 2 diabetes, followed by cardio-renal protective medications.Good
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