Treating hyperglycaemia used to be straightforward. In fact, until the late 1990s, the clinicians choice was limited to Metformin, sulphonylureas and human insulin. However, over the last 15 years, our increasing understanding of the pathophysiology of diabetes has lead to a plethora of new agents belonging to a variety of classes – with more in the pipeline. Whilst metformin is universally considered first line therapy, increasingly the issue has been what next?

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