Combination Therapy for Type 2 Diabetes

Rationale for Combination Therapy

Combination therapy with metformin and pioglitazone is recommended when glycemic targets cannot be maintained with metformin monotherapy, due to the progressive nature of type 2 diabetes, as suggested by the American Diabetes Association guidelines 1, 2
The American Diabetes Association guidelines list thiazolidinediones, including pioglitazone, as one of the six preferred treatment options that can be added to metformin for patients with type 2 diabetes 3, 4

The addition of pioglitazone to metformin results in an additional reduction in HbA1c of approximately 0.7-1.0% compared to metformin alone, in patients with type 2 diabetes 2

Patients taking metformin should be monitored for gastrointestinal intolerance and vitamin B12 deficiency, as recommended by the American Diabetes Association 2, 5

For patients with established atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease, the American Diabetes Association recommends considering an SGLT2 inhibitor or GLP-1 receptor agonist with demonstrated cardiovascular benefit, independent of A1C levels 5
Initial combination therapy with metformin and pioglitazone may be considered for patients with A1C levels 1.5-2.0% above target, for more rapid attainment of glycemic goals, as suggested by the American Diabetes Association guidelines 2, 3