The Annals of Internal Medicine has featured a Clinical Practice Guideline on oral drugs for type 2 diabetes, produced by the American College of Physicians.  The guideline is based on a review of the comparative effectiveness and safety of these agents, including metformin, sulfonylureas, meglitinides, thiazolidinediones, dipeptidyl peptidase (DDP)-4 inhibitors and glucagon-like peptide (GLP)-1 agonists. 

The ACP recommends that clinicians prescribe an oral drug for patients diagnosed with type 2 diabetes when diet and exercise fail to adequately control hyperglycaemia.  Metformin monotherapy is recommended as the first-line option unless contraindications exist; a second drug should be added if this fails to control glucose levels adequately.  The authors report that all dual regimen combination therapies reduce HbA1c levels by around 1% compared to monotherapy, and that there was insufficient evidence upon which to recommend a specific combination.