Endocrine Abstracts

Before releasing of SGLT-2 inhibitor, triple combination of metformin, DPP-4 inhibitor and TZD except sulfonylurea was commonly used in our center because it could be best option for delaying progression of diabetes by improving both insulin resistance and secretory dysfunction. SGLT-2 inhibitor is commonly used and recommended as initial combination with metformin in most guidelines because of cardiovascular risk and weight reduction, but theoretically add on to above combination can be more effective because of less pancreatic beta cell reserve and relatively high risk of cardiovascular event in long duration of diabetes. But there are few studies about multiple combination therapy with SGLT-2 inhibitor. And triple combination therapy of metfomin, SGLT-2 inhibitor with DPP-4 inhibitor or TZD is not covered by insurance in this country, so we tried to know the effect of that. We recruited 36 patients of triple combination therapy with metformin, DPP-4 inhibitor and TZD and dapagliflozin was added without changing previous dose of triple combination. The difference in HbA1c was compared between mean of 3 months and just before and mean of 3 and 6 months after add on. Weight change was also assessed after 6 months. The mean age was 53.3 years old and duration of diabetes was 11.6 years. 69% of patients have dyslipidemia and 52% have hypertension or proteinuria. The initial mean HbA1c before add on was 8.28±0.76 and it was decreased to 7.33±0.55. The mean decrement was 0.95±0.69. The initial BMI was 26.2±4.2 and body weight was decreased by 2.10±2.28 kg. Add on therapy of dapagliflozin to previous anti-diabetic medication with triple combination therapy was effective both in both glucose control and weight reduction, so it could be more effective than initial combination with metformin in longer duration of diabetes with relatively high cardiovascular risk.