Insulin and Oral Hypoglycemics

A 52-year-old man with type 2 diabetes on metformin alone presents with fasting blood glucose 180 mg/dL and HbA1c 8.5%. His renal function is normal, and he has no history of hypoglycemia. Which feature best distinguishes DPP-4 inhibitors from sulfonylureas as the next agent to add?

A 52-year-old man with type 2 diabetes mellitus presents with a 3-month history of progressive polyuria, polydipsia, and weight loss despite being on metformin 1000 mg twice daily for the past 2 years. His current HbA1c is 9.2% (target <7%). Fasting blood glucose is 185 mg/dL and postprandial glucose is 245 mg/dL. He has no contraindications to any antidiabetic agent. What is the most appropriate next step in management?

A 58-year-old man with type 2 diabetes mellitus on metformin monotherapy presents with persistent hyperglycemia (FBS 180 mg/dL, PPBS 240 mg/dL). Regarding the addition of a second agent, all of the following statements about DPP-4 inhibitors are true EXCEPT:

A 52-year-old man with type 2 diabetes mellitus on metformin 1000 mg BD presents with a 3-month history of progressive polyuria, polydipsia, and weight loss. His current HbA1c is 9.2%. Physical examination reveals no signs of diabetic ketoacidosis. Fasting blood glucose is 186 mg/dL and postprandial glucose is 248 mg/dL. What is the most appropriate next step in management?

A 48-year-old woman with type 2 diabetes mellitus on metformin and glibenclamide (glyburide) presents to the emergency department with confusion, diaphoresis, tremor, and a capillary blood glucose of 42 mg/dL. She denies recent illness or change in medication. Her husband reports she had skipped breakfast 2 hours ago. After confirming hypoglycemia with a laboratory glucose measurement, what is the most appropriate immediate next step?