metformin + DPP-4 inhibitor + SGLT2 inhibitor

A triple combination oral therapy consisting of **metformin**, a **dipeptidyl peptidase-4 (DPP-4) inhibitor**, and a **sodium-glucose co-transporter-2 (SGLT2) inhibitor** is used primarily for the management of **type 2 diabetes mellitus** in adults inadequately controlled on metformin alone or in combination with either a DPP-4 inhibitor or an SGLT2 inhibitor. - **Metformin** decreases hepatic glucose production and improves insulin sensitivity. - **DPP-4 inhibitors** decrease inactivation of incretins, enhancing glucose-dependent insulin release and inhibiting glucagon secretion. - **SGLT2 inhibitors** decrease renal glucose reabsorption, increase urinary glucose excretion, and have secondary benefits on weight and blood pressure. This combination targets multiple pathophysiological defects in type 2 diabetes, leading to complementary efficacy, improved glycemic control, and a favorable safety profile (low hypoglycemia risk, weight neutrality or loss). Used either as separate agents or, increasingly, as fixed-dose combinations. The specific branded triple combination with all three components in a single product is rare but combinations with two components (e.g., SGLT2 inhibitor + metformin, DPP-4 inhibitor + metformin, or SGLT2 inhibitor + DPP-4 inhibitor) exist. Individual companies may market specific fixed-dose triple combination products regionally[1][2][3][4].