There is almost no other disease as pervasive as type 2 diabetes, a disease that has touched almost every family in America. Although there was a time when we had limited management tools, we now have ten classes of medications plus many kinds of insulin available as options.  The result is a choice of many treatment combinations, which, however welcome, can also be overwhelming for the practicing physician. With so many choices it becomes very hard to decide what comes after metformin.

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