Linagliptin (Tradjenta – Boehringer Ingelheim/Lilly), a third oral dipeptidyl peptidase-4 (DPP-4) enzyme inhibitor, was recently approved by the FDA for treatment of type 2 diabetes, either alone or in combination with metformin, a sulfonylurea or pioglitazone.

DRUGS FOR DIABETES — Metformin (Glucophage, and others) is generally preferred as the first-line oral hypoglycemic agent. A sulfonylurea, such as glimepiride (Amaryl, and others), is less likely than metformin to be effective as monotherapy and may cause weight gain and hypoglycemia. The thiazolidinedione pioglitazone (Actos) is effective for glycemic control, but can also cause weight gain, increases the risk of heart failure and was recently removed from the market in France and Germany because of concerns about an association with bladder cancer. If the desired glycated hemoglobin (A1C) goal is not achieved with metformin, ... more      

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