dpp4 inhibitor + metformin + sulfonylurea

This is a triple combination therapy consisting of a **DPP-4 inhibitor** (such as sitagliptin, saxagliptin, linagliptin, or alogliptin), **metformin**, and a **sulfonylurea** (such as glimepiride, glibenclamide/glyburide, or gliclazide). Each component works through a distinct mechanism to lower blood glucose in people with type 2 diabetes mellitus. DPP-4 inhibitors prevent the breakdown of incretin hormones, increasing insulin release and decreasing glucagon secretion. Metformin decreases hepatic glucose production and improves insulin sensitivity. Sulfonylureas stimulate pancreatic beta cells to increase insulin secretion. This triple combination is considered for people with type 2 diabetes who are inadequately controlled on dual therapy and have not yet progressed to, or refuse, insulin therapy. No fixed-dose triple combination with these three components is marketed under a single brand name, but they are often prescribed together in clinical practice[2].