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module menu icon Third-line treatment

Triple therapy

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

For individuals who can take metformin, the following triple therapy combinations should be considered:

  • Metformin plus a DPP-4i and a sulfonylurea
  • Metformin plus pioglitazone and a sulfonylurea
  • Start insulin therapy.
  • For individuals who cannot take metformin (whether it is contraindicated or not tolerated), insulin therapy should be considered.

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