What is the best method for achieving glycemic control in type 2 diabetes after metformin therapy?

Implementing a GLP-1 receptor agonist is often considered the best method for achieving glycemic control in type 2 diabetes after metformin therapy due to several reasons. GLP-1 receptor agonists work by enhancing insulin secretion in response to meals, reducing glucagon release, and slowing gastric emptying, which collectively contributes to improved postprandial and overall glycemic control.

Additionally, these medications have beneficial effects on weight management, as they often promote weight loss, which can be particularly advantageous for many individuals with type 2 diabetes who may also struggle with obesity. They also have a relatively low risk of causing hypoglycemia, especially when compared to insulin therapy, which requires careful dosage management to prevent such events.

In contrast, while adding a DPP-4 inhibitor can be an effective strategy, these agents primarily work by prolonging the activity of incretin hormones but may not provide the same level of glycemic control or weight benefits as GLP-1 receptor agonists. Relying solely on dietary modifications alone may not sufficiently address the need for pharmacologic intervention in patients who have not achieved target glycemic levels with metformin. Using insulin therapy, while effective, may lead to an increased risk of weight gain and hyp