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Key Points Clear messages came out of UKPDS, for example… results established that lowering blood glucose levels in type 2 diabetes with intensive therapy conferred clear benefit in retinopathy, nephropathy, and perhaps neuropathy length of time with which the patient lives with hyperglycemia is critically important glycemic control does deteriorate over time. UK Prospective Diabetes Study Group (UKPDS). Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352:837-53. Key Points As we have said, certain criteria must be considered when making a drug selection. Patients with higher A1C at the outset – 8.0 or higher – will benefit from more effective medications. But for all patients, we need to consider safety, tolerability, and what effect the drug has on weight, CVD risk, and beta-cell preservation. Finally, there is the issue of cost. Key Points This graphic depicts the relative A1C reductions seen through treatment with monotherapy. Metformin and the sulfonylureas/glinides demonstrate the same rate of reduction, at -1.5%. Key Point To date, there is no data that demonstrates the superiority of one class over another in reducing microvascular complications. Key Points The American Diabetes Association and the European Association for the Study of Diabetes had previously issued a consensus algorithm for medical management of type 2 diabetes, which was updated in January 2008 to address safety issues on thiazolidinediones. With the advent of newer drugs/classes, this algorithm has been further updated. Nathan DM et al. Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 2009;52:17-30; Diabetes Care 2009;32:193-20