A systematic review and meta‐analysis of the relative benefit of dual versus single oral hypoglycaemic therapy following diagnosis with type 2 diabetes ( T2D )
Pooled result · HbA1c ≤7.5% (58 mmol/mol)Result — go to the resultOdds ratio 1.33 95% CI 1.20–1.47Authors' conclusion
Initial dual therapy, particularly combining metformin with an SGLT2-i, results in superior achievement of HbA1c targets across various thresholds compared to monotherapy. SGLT2-i alone surpasses metformin alone in efficacy. Adding a second agent to SGLT2-i did not provide additional glucose-lowering benefit to SGLT2-i monotherapy.
Study context
- Population
- Patients with treatment-naive or early-stage T2D; RCTs from PubMed and Cochrane Library, 2005 to 202520 trials · 37 treatment arms
- Comparison
- Initial dual oral therapy vs monotherapy
- Outcome
- Proportion of treatment arms achieving HbA1c ≤7.5% (58 mmol/mol)
Methodological detailsrandom-effects inverse-variance meta-analysis, parallel-group RCTs ≥12 weeks
- Random-effects inverse-variance meta-analysis
- Parallel-group RCTs ≥12 weeks
Pooled result
HbA1c ≤7.5% (58 mmol/mol)
Odds ratio
1.33
95% CI 1.20–1.47
P = 0.002
By group
Dual therapyvs Monotherapy
OR 1.33 (95% CI 1.20–1.47); P = 0.002
As reported in the abstract
Further pooled results
HbA1c ≤7.0% (53 mmol/mol)
OR 1.27 · P = 0.003
HbA1c ≤6.5% (48 mmol/mol)
OR 1.18 · P = 0.056
%
| Outcome | Dual therapy | Monotherapy | Mean difference (%) (95% CI) | P value | |
|---|---|---|---|---|---|
| Pooled final HbA1c | 6.7 (50 mmol/mol) | 7.9 (63 mmol/mol) | −0.45 (−0.60 to −0.25) | P ≤ 0.001 | |
| −1−0.500.5Difference, % (linear scale) |
| Outcome | Dual therapy | Monotherapy | OR | P value |
|---|---|---|---|---|
| HbA1c ≤7.0% (53 mmol/mol): dual therapy vs metformin monotherapy | 86% | — not stated in the abstract | 1.41 | P = 0.001 |
| HbA1c ≤7.5% (58 mmol/mol): metformin + SGLT2i vs metformin aloneDifference significant across all thresholds | 1.55 | P ≤ 0.001 | ||
| HbA1c ≤7.5% (58 mmol/mol): SGLT2i-containing dual therapy vs all monotherapies | — not stated in the abstract | 82% | 1.43 | P ≤ 0.001 |
| Reaching target: SGLT2i monotherapy vs metformin | 1.73 | P ≤ 0.001 | ||
| Outcome: dual therapy vs monotherapy involving SGLT2i | 0.87 | P = 0.480 |
— not stated in the abstract
- HbA1c ≤7.0% (53 mmol/mol): dual therapy vs metformin monotherapy: Metformin 81%
- HbA1c ≤7.5% (58 mmol/mol): metformin + SGLT2i vs metformin alone: Metformin + SGLT2i 88%
- HbA1c ≤7.5% (58 mmol/mol): metformin + SGLT2i vs metformin alone: Metformin 81%
- HbA1c ≤7.5% (58 mmol/mol): SGLT2i-containing dual therapy vs all monotherapies: SGLT2i dual therapy 87%
- Reaching target: SGLT2i monotherapy vs metformin: SGLT2i 89%
- Reaching target: SGLT2i monotherapy vs metformin: Metformin 81%
Outcome: dual therapy vs monotherapy involving SGLT2i
- No significant difference in outcome between dual and monotherapy involving SGLT2i
Heterogeneity and sensitivity
- Heterogeneity low to moderate (I2 25%-50%)
- Results consistent after excluding rosiglitazone arms
Original publication
A systematic review and meta‐analysis of the relative benefit of dual versus single oral hypoglycaemic therapy following diagnosis with type 2 diabetes ( T2D ). Diabet Med. Published 21 May 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →