Most experts agree that lifestyle modifications and metformin (Glucophage, and others) should be used first to treat patients with type 2 diabetes.1 If metformin alone fails to control hyperglycemia, there is no general agreement on which drug should be added next. A recent article in The Medical Letter offered some support for a sulfonylurea.2 Three recent trials published in The Lancet favored the long-acting basal insulin glargine, the glucagon-like peptide (GLP-1) analog exenatide, and the dipeptidyl peptidase-4 (DPP-4) inhibitor linagliptin, respectively.3,4,5 Some of the advantages and disadvantages of these and other available agents are listed in Table 1.

RECOMMENDATIONS — When metformin does not adequately control hyperglycemia, addition of a sulfonylurea appears ... more      

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