The sequential treatment approach is often compounded by substantial clinical inertia to timely treatment intensification. Substantial clinical inertia exists at each sequential intensification step.

At HbA1c 8.0% to 8.5%, HbA1c-lowering is slightly greater with DPP-4 inhibitors than with SGLT2 inhibitors as an add-on to metformin.

SGLT2 inhibitors are associated with larger HbA1c levels.

DPP-4 inhibitors moderate the risk of genitourinary tract infections associated with SGLT2 inhibitors.

In cases of HbA1c ≥8.0%, dual DPP-4 inhibitors-SGLT2 inhibitors add-on therapy to metformin should be considered to help more patients achieve glycemic targets.

Real-world evidence with empagliflozin and linagliptin FDC conducted across India involving 1232 T2D patients showed a significant reduction in HbA1c, FPG, PPG, weight and BP.