Dual therapy

If the first-line treatments are ineffective and blood glucose is not being controlled effectively, a second antidiabetic drug should be added (dual therapy).

For individuals who can take metformin, the following dual therapy combination should be considered:

• Metformin and a DPP-4i
• Metformin and pioglitazone
• Metformin and a sulfonylurea
• Metformin and a SGLT-2 inhibitor (only where a sulphonylurea is not suitable or the patient is at risk of hypoglycaemia).

For individuals who cannot take metformin, the following combination dual therapy should be considered:

DPP-4i and pioglitazone DPP-4i and a sulfonylurea Pioglitazone and a sulfonylurea.