Glargine and liraglutide are the best second drugs after metformin for achieving tight glycemic control (in a study without SGLT2 inhibitors)

Clinical Question

For patients with fair glycemic control who are taking metformin, what is the best second drug to add to improve glycemic control?

Bottom line

If all you care about is glycemic outcomes, then liraglutide and insulin glargine are for you, although the latter has higher rates of serious adverse events. But we know that tight glycemic control in middle-aged and older patients with diabetes does not reduce, and may increase, mortality. What really matters is the impact on patient-oriented outcomes — and that is addressed in a companion POEM, Liraglutide probably the best second drug to prevent cardiovascular events in patients with T2DM who take metformin. 1b

Study design: Randomized controlled trial (single-blinded)

Funding: Government

Setting: Outpatient (any)


Mark H. Ebell, MD, MS
University of Georgia
Athens, GA

Discuss this POEM



Glycemia Reduction in Type 2 Diabetes - Glycemic Outcomes

The conclusions of the reviewers are apparently different from the conclusions of the researchers.


Tight control of sugars not necessarily needed in middle age

Surprised that the risks and side effects of attempting tight glycemic control in the middle age and elderly is not really necessary


in my practice I did not notice that Sitagliptin is more eff

I am wondering since the study was conducted for few years why the study did not report cardiovascular outcomes, CHF , etc
also it did not since that DDP4 sitagliptin was more effective than Liraglutide in reducing HbaA1c I am concerned about adherence, randomization and blindness

Alejandra Cervantes Hernandez


I find this relevant in my practice as Family Physician and Hospitalist. Potentially useful for Emergency Medicine as well.


liraglutide and glimepride in dm

2nd best after metformin