The American College of Physicians (ACP) has updated its clinical practice guideline on oral pharmacologic treatment of type 2 diabetes. The guideline authors looked at studies involving metformin, thiazolidinediones, sulfonylureas, dipeptidyl peptidase-4 (DPP-4) inhibitors, and sodium–glucose cotransporter-2 (SGLT-2) inhibitors. They recommend that clinicians:

• Prescribe metformin to patients with type 2 diabetes when pharmacologic therapy is needed to improve glycemic control.
• Consider adding either a sulfonylurea, a thiazolidinedione, an SGLT-2 inhibitor, or a DPP-4 inhibitor to metformin to improve glycemic control when a second oral therapy is considered; however, ACP called this a weak recommendation based on moderate-quality evidence.

ACP recommends that clinicians and patients select among medications after discussing benefits, adverse effects, and costs.