The authors performed a systematic review and meta-analysis on CV and renal outcomes of initial combination therapy with glucose-lowering drugs vs a stepwise approach in newly-diagnosed or treatment naïve T2DM.

Based on a very limited number of studies they found that initial combination therapy improved cardiometabolic and glycaemic parameters, but had similar effects in efficacy and safety compared to stepwise therapy with respect to cardiorenal outcomes.

Despite inadequately powered data which is a clear weakness of the analysis the paper provides a good summary of evidence in this context and more research should be required on that matter. The manuscript is well structured and written.

There are a few points which should be addressed:

1) the authors should add some explanations why combination thearapy with basal insulin and GLP1-RAs, or basal insulin plus OAD (vs OAD alone) were not considered or the focus was only on oral treatments

2) was there only free combinations investigated? Why no fixed oral combinations included? please explain in more detail.