Type 2 diabetes mellitus (T2DM) represents a significant and escalating global health challenge, characterized by chronic hyperglycaemia resulting from insulin resistance, impaired insulin secretion, or both. The long-term complications associated with T2DM, including cardiovascular disease, nephropathy, retinopathy, and neuropathy, impose a substantial burden on individuals and healthcare systems worldwide. While current management strategies primarily focus on achieving and maintaining glycaemic control to prevent these complications, the concept of achieving disease remission has gained increasing attention as a more ambitious and potentially impactful therapeutic goal. Remission, defined as the sustained achievement of non-diabetic glycaemic levels without the need for glucose-lowering medications, holds the promise of reducing the risk of long-term complications, improving patients’ quality of life, and potentially decreasing healthcare expenditures.

This pilot study aims to investigate the efficacy and safety of a novel triple combination therapy involving Tirzepatide, Dapagliflozin, and Metformin for inducing remission in patients with type 2 diabetes. Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, represents a new class of incretin-based therapies demonstrating remarkable efficacy in glycaemic control and weight loss ¹. Dapagliflozin, a selective sodium-glucose cotransporter-2 (SGLT2) inhibitor, lowers blood glucose by increasing urinary glucose excretion and has shown significant cardiovascular and renal benefits ². Metformin, a biguanide, remains the cornerstone of initial pharmacological treatment for T2DM due to its effectiveness in reducing hepatic glucose production and improving insulin sensitivity, coupled with a favourable safety profile and long-term cardiovascular benefits ⁴. By combining these three agents, each with distinct yet complementary mechanisms of action, this study seeks to explore the potential for a synergistic effect that could lead to a higher rate of diabetes remission compared to existing treatment paradigms.