Type 2 diabetes develops when the body can no longer use insulin as well as it should. Insulin is a hormone that helps move sugar from the blood into cells, where it can be used for energy.
When this process does not work properly, sugar builds up in the blood and can damage the body over time.
Metformin is often the first medicine prescribed to people with type 2 diabetes. It helps the body respond better to insulin and reduces the amount of sugar released by the liver. However, diabetes can change over time, and metformin alone may eventually fail to keep blood sugar within a healthy range.
Researchers at Thomas Jefferson University studied whether adding two different diabetes medicines could provide better long-term control. The medicines were dapagliflozin, which is taken as a daily pill, and exenatide, which was given as a once-weekly injection. The findings were published in the journal Diabetes Care.
The study included 695 adults with type 2 diabetes whose blood sugar remained too high despite treatment with metformin. Participants were given exenatide, dapagliflozin, or both medicines together while continuing metformin. Researchers then followed them for two years to see how well the treatments worked over time.
The combination produced the strongest results. People who received both dapagliflozin and exenatide had better blood sugar control than those who received either medicine alone. Importantly, the benefit continued during the two-year study rather than quickly fading.
The two medicines attack the problem in different ways. Dapagliflozin helps the kidneys remove extra sugar from the blood and send it out of the body through urine. This means it can lower blood sugar without depending directly on insulin.
Exenatide works differently by copying some of the actions of a natural hormone released after eating. It helps the body release more insulin when blood sugar is high and reduces the amount of sugar released by the liver. It can also slow the movement of food through the stomach and help people feel full for longer.
Because the medicines work through different pathways, researchers believed that combining them could provide a stronger effect. The results supported that idea. The combination did more than improve blood sugar levels.
People receiving both medicines also lost weight and experienced improvements in blood pressure. These changes are important because type 2 diabetes often occurs alongside excess weight and high blood pressure. Together, these conditions can raise the risk of heart disease, stroke, kidney disease and other serious health problems.
The researchers also found no unexpected safety problems during the two-year study. That is important when doctors consider treatments that may need to be taken for many years. However, every diabetes medicine can have side effects, and the best treatment depends on a person’s overall health and other medical conditions.
Lead researcher Dr. Serge Jabbour said the results support using medicines with different actions when metformin is no longer enough. Modern diabetes treatment increasingly looks beyond blood sugar alone and considers other health issues, including body weight, heart health and kidney health. Having medicines that can address several of these concerns may be especially useful.
The findings do not mean that everyone taking metformin should automatically receive these two additional drugs. Diabetes treatment needs to be chosen for each individual, and factors such as other medicines, kidney function, side effects and cost can influence the decision. Patients should talk with their doctor before making any change to their treatment.
Still, the study offers encouraging evidence for people who need more help after metformin. Combining dapagliflozin and exenatide provided stronger and lasting blood sugar control while also helping with weight and blood pressure. For a lifelong condition such as type 2 diabetes, those wider benefits could make a meaningful difference.
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