The HR for progression for metformin plus pioglitazone with lifestyle therapy was 0.29 (95% CI 0.11-0.78) and the HR for progression for metformin, pioglitazone plus GLP-1 agonist with lifestyle therapy was 0.12 (95% CI 0.02-0.94).
A related commentary discusses this research. Since evidence exists in favour of the thesis that by the time of diagnosis of type 2 diabetes 80% of β-cell function is already lost, intervening with therapies designed to interrupt the pathophysiological mechanisms that lead to type 2 diabetes is logical. Many would consider intervention with three pharmaceutical agents, one of which is an injectable, to be excessive in this population. However, the complications of type 2 diabetes can be devastating and anything that can be done to avoid diabetes and therefore its complications is worthy of consideration. Together with recent results describing an alternative approach to reverse the underlying metabolic defects in type 2 diabetes—the very low calorie diet used in the DiRECT study—among others, the findings from this timely real-world study will undoubtedly stimulate debate in this area.