After Metformin — Next Steps for Type 2 Diabetes with Low Cardiovascular Risk

This editorial discusses the findings and implications of the GRADE trial, which compared four glucose-lowering drugs insulin glargine, glimepiride, liraglutide, and sitagliptin as add ons to metformin in patients with type 2 diabetes at low cardiovascular risk. While all agents improved glycemic control, liraglutide and insulin glargine were most effective in maintaining target HbA1c levels. Liraglutide showed a reduction in cardiovascular risk. The authors highlight limitations in the study design and suggest a personalized approach for treatment based on glycemic phenotype.

This editorial discusses the findings and implications of the GRADE trial, which compared four glucose-lowering drugs insulin glargine, glimepiride, liraglutide, and sitagliptin as add ons to metformin in patients with type 2 diabetes at low cardiovascular risk. While all agents improved glycemic control, liraglutide and insulin glargine were most effective in maintaining target HbA1c levels. Liraglutide showed a reduction in cardiovascular risk. The authors highlight limitations in the study design and suggest a personalized approach for treatment based on glycemic phenotype.