Triple combination therapy lowered HbA1c more than dual therapy in type 2 diabetes
Last updated May 6, 2026
Key finding
In Indian adults with type 2 diabetes not controlled on metformin alone, the fixed-dose triple combination of glimepiride, voglibose, and extended-release metformin lowered HbA1c more than either dual combination over 24 weeks, with few mild side effects.
This 24-week Indian trial compared a triple fixed-dose tablet with two dual-drug tablets in adults with type 2 diabetes who were still above target on metformin alone. All groups improved, but the triple combination lowered HbA1c more and helped more people reach an HbA1c below 7%, without more serious safety problems.
Quick read
Study at a glance
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EvidenceScore™
Moderate
Study type
Randomized Controlled Trials (RCTs)
Follow-up
Medium-Term (3–12 mo)
Risk of bias
Some Concerns
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Plain-language summary
What this paper says
A plain-language read of the study’s main message and where it applies.
Study focus
In Indian adults with type 2 diabetes not controlled on metformin alone, the fixed-dose triple combination of glimepiride, voglibose, and extended-release metformin lowered HbA1c more than either dual combination over 24 weeks, with few mild side effects.
Published in
Journal Reference
Publication details and source links for this paper.
Mohan B, Kumar SV, Kurmi PH, et al. Efficacy and Safety of Glimepiride, Voglibose, and Metformin ER in Type 2 Diabetes: A Randomized, Active-Controlled Study. J Diabetes. 2026;18(4):e70217. doi:10.1111/1753-0407.70217
Main Effects
HbA1c ↓ by 1.57% at 24 weeks with triple therapy
More patients reached HbA1c <7% with triple therapy
Fasting glucose ↓ in all treatment groups
Postprandial glucose ↓ in all treatment groups
Hypoglycemia ↔ rare and no severe events were reported
Evidence Suggest
- HbA1c fell more with glimepiride plus voglibose plus extended-release metformin than with either dual-drug comparator at both 12 and 24 weeks.
- By 24 weeks, 62.3% of patients on triple therapy reached HbA1c below 7%, compared with 30.0% and 35.7% in the dual-therapy groups.
- Only two level 1 hypoglycemia events were reported overall, and no serious or severe adverse events occurred.
Who this applies to
These findings apply most directly to adults aged 18 to 65 years with type 2 diabetes in India who remain above target despite stable metformin monotherapy, and who do not have major renal, hepatic, or gastrointestinal exclusion conditions. The results are most relevant to patients with HbA1c between 7.5% and 9.0%.
Keep in Mind
All three treatments improved glucose control, so the main question is the size of the extra benefit from the triple combination. The primary endpoint was an objective lab measure, which strengthens confidence, but the open-label design and industry funding still matter. The study also used fixed-dose combinations and dose uptitration rules that may not fully match every real-world setting.
Between the Lines
- The study was open-label, so participants and clinicians knew which treatment was given.
- The trial included only adults in India with baseline HbA1c up to 9%, so results may not apply to all people with type 2 diabetes.
- Follow-up lasted 24 weeks, so longer-term durability and safety are still uncertain.
- The study was funded by the manufacturer, which increases the need for independent confirmation.
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