metformin + SGLT2 inhibitor + GLP-1 receptor agonist

This is a combination therapy consisting of three distinct classes of antihyperglycemic agents used in the management of type 2 diabetes mellitus: - **Metformin** is a biguanide that primarily decreases hepatic glucose production and improves insulin sensitivity. - **SGLT2 inhibitors** (sodium-glucose cotransporter 2 inhibitors) reduce renal glucose reabsorption, leading to increased urinary glucose excretion and lower blood glucose levels. Common agents include canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin[1][2][5]. - **GLP-1 receptor agonists** (glucagon-like peptide 1 receptor agonists) mimic endogenous GLP-1 to enhance insulin secretion in a glucose-dependent manner, suppress glucagon release, slow gastric emptying, and promote satiety[6][7]. The combination leverages complementary mechanisms for improved glycemic control with low risk of hypoglycemia. Clinical evidence suggests this triple therapy may provide additive benefits for cardiovascular and renal outcomes compared to monotherapy or dual therapy regimens[4][9]. This regimen is typically prescribed when glycemic targets are not achieved with fewer agents.