What Therapy Is Best for Diabetes After Metformin Fails?

Metformin is accepted widely as first-line treatment for patients with type 2 diabetes, but no clear guidelines exist on how to proceed when metformin monotherapy fails. In three new industry-supported studies, researchers compared available second-line treatments.

In an open-label study, 1029 adults with glycosylated hemoglobin (HbA_1c) levels between 6.5% and 9.0% while taking metformin were randomized to add either the glucagon-type peptide-receptor agonist exenatide (Byetta; 5–10 µg subcutaneously twice daily) or the sulfonylurea glimepiride (titrated to maximum tolerated daily dose). During 4 years of follow-up, significantly fewer exenatide recipients than glimepiride recipients (41% vs. 54%) reached the primary endpoint of treatment fa…