Type 2 no Insulin

Who is number one after metformin?

I was at a speaker training, where I learn about a new drug so I can give a lecture on it to community physicians.  The main lecture is held in a huge room in a hotel for most of the day with 200-300 physicians, mostly endocrinologists.  Toward the end, it is held in a smaller breakout sessions of only 25-30 broken down by region.

So, I was there in the room with about 30 doctors, only some I knew very closely.  The moderator of the session had time to kill because the projector was not working.  He asked a great question.

What do you guys like to use after metformin?

He went through all the medication classes one by one as people raised hands: SFU, TZD, DPP-4 GLP-1 insulin

The answers were very mixed and the physicians complained to each other about cost, side effects, injections vs pills, safety issues, etc… debated ensued. 

The moderator hushed the crowd and asked the question again, but adding if cost was not an issue.  He went through the same list and the results were better, but still some what mixed.  Debate and egos flared once again.

The moderator hushed the crowd again and asked the question one last time.  This time adding if cost or injection was not an issue.  I can see what he was doing.  He was asking us the fundamental, physiological, base bones question of which class is actually the best.  He went through the entire list again and I watched in anticipation because i wanted to know what my other colleagues thought and if it matched what I thought. 

It was pretty much unanimous: GLP-1

We were at a SGLT-2 speaker training, so it’s interesting and refreshing to know the truth about the order of the classes and what medication class we should use after metformin. 

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