Challenges to good glycemic control – The ‘deadly’ triad: Progressive disease; clinical inertia; poor adherence to management regimens. Intensive treatment/risk factor modification reduces CV events in T2DM. Delay in glycemic control leads to clinical inertia, which directly impacts the quality of healthcare. Thus, DM should be addressed in early stages of the disease. The natural progression of diabetes and associated complications can be prevented by early initiation and intensification with vildagliptin and metformin combination. The recent INITIAL study shows effectiveness and safety of vildagliptin + metformin initial combination therapy in drug-naive patients with T2DM. At 24 weeks, 39.6% of patients achieved HbA1c ≤ 7.0%. There were no serious adverse events or deaths during the complete study.