Early combination therapy delayed treatment escalation in newly-diagnosed young-onset type 2 diabetes - a sub-analysis of VERIFY study.

Chan, Juliana Cn; Paldánius, Päivi M; Mathieu, Chantal; Stumvoll, Michael; Matthews, David R; Del Prato, Stefano

We analysed glycaemic durability (sustained glycaemic control) with early combination therapy (metformin plus vildagliptin) versus metformin monotherapy, among patients with type 2 diabetes diagnosed before (young-onset [YOD]) and after (late-onset [LOD]) the age of 40 years, enrolled in the VERIFY trial. The primary endpoint was time to initial treatment failure (TF), defined as HbA1c ≥7.0% at two consecutive scheduled visits after randomisation. The time to secondary TF was assessed when both groups were receiving and failing on the combination. A total of 186 (9.3%) patients had YOD and 1815 (90.7%) had LOD with a mean age difference of 20.4 years. Compared with metformin monotherapy, early combination reduced the risk of time to initial TF for both YOD (48%, p < 0.0006) and LOD (46%, p < 0.0001). With early combination, risk for time to secondary TF was reduced by 48% (p < 0.0035) in YOD and 24% (p < 0.0009) in LOD. Both treatment approaches were well-tolerated with no unexpected safety concerns. In treatment-naïve patients with YOD (HbA1c 6.5-7.5%), early combination strategy improved attainment of glycaemic target with durability and delayed treatment escalation compared with initial metformin monotherapy. This article is protected by copyright. All rights reserved.