What do you do when metformin alone fails?

A quiz to test your clinical skills


This content has been produced by Australian Doctor Group with an independent educational grant from MSD Australia.



At least 20% of patients with type 2 diabetes may be under-treated due to “clinical inertia”, research suggests.1,2

Australian guidelines provide a step-wise approach to diabetes management with clear first-line recommendations, but when it comes to second-line options, GPs may lack confidence when choosing the right treatment and delay stepping up from metformin monotherapy to combination therapy.2–4

In addition, the failure to step up medication when needed may also be due to the array of treatment options that have become increasingly complex – especially when it comes to selecting second-line therapies available on the PBS.5

What are the clinical considerations when selecting a second-line option for your patients?

Check your skills with this quick quiz.

This content has been reviewed by GP consultant Dr Elizabeth Harris.

References: 1. Jiwa M et al. Diabetes Res Clin Pract 2012; 95 (3): 326–32. 2. Deed G, Barlow J & Kuo I. Aust Fam Physician 2012; 41(9): 68–84. 3. Gunton JE et al. A new blood glucose management algorithm for type 2 diabetes: a position statement of the Australian Diabetes Society. December 2016. Available online: https://diabetessociety.com.au/documents/ADS_POSITIONSTATEMENT_v2.4.pdf Accessed 27/6/17. 4. The Royal Australian College of General Practitioners and Diabetes Australia, General Practice Management of Type 2 Diabetes – 2016–18. Melbourne: 2016. 5. NPS Medicinewise. Type 2 diabetes: when metformin is not enough. 1 June 2016. 6. Pharmaceutical Benefits Scheme, November 2017. 7. NPS Radar. Pharmacological therapies in Australia for type 2 diabetes. 1 December 2015. 8. Approved Product Information for Forxiga, October 2016. 9. Approved Product Information for Invokana, October 2017. 10. Zinman B et al. N Engl J Med 2015; 373: 2117–28. 11. Approved Product Information for Jardiance, August 2017. 12. Marso SP et al. N Engl J Med 2016; 375: 315–22. 13. Approved Product Information for Victoza, January 2017.