SMART-DM: Simplified Diabetes Management for Primary Care Physicians
DOI:
https://doi.org/10.59793/mgb4ft07Keywords:
Type 2 diabetes mellitus,, triple combination therapy,, metformin, dapagliflozin,, sitagliptin, fixed-dose combination,, SMART-DMAbstract
Type 2 diabetes mellitus (T2DM) is a progressive metabolic disorder characterized by insulin resistance and declining
beta-cell function, often leading to chronic hyperglycemia and associated complications. Despite the availability of various
pharmacological agents, glycemic control remains suboptimal in a significant proportion of patients, particularly when relying
solely on monotherapy or delayed combination strategies. This review explores the current challenges in diabetes management
within primary care settings, highlighting the limitations of monotherapy and dual therapy approaches. It emphasizes the role
of early, individualized treatment intensification using triple combination therapy involving metformin, dapagliflozin, and
sitagliptin. This combination targets complementary pathophysiological pathways - hepatic glucose production, renal glucose
reabsorption, and incretin hormone regulation - offering superior glycemic control, reduced risk of hypoglycemia, weight
management, and cardiorenal benefits. The SMART-DM framework is introduced as a simplified and actionable approach to
guide physicians in optimizing diabetes care. In alignment with global and national clinical guidelines, this review supports
the timely adoption of fixed-dose triple therapy to overcome clinical inertia and improve treatment adherence. Additionally,
the review discusses evidence from key clinical trials, patient selection considerations, and safety profiles, thereby providing a
comprehensive guide for health care practitioners aiming to enhance long-term outcomes in patients with T2DM.
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