After metformin, what is the best oral agent for use in patients with type 2 diabetes without comorbidities?

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No clear “best oral agent” exists to add to metformin. Sodium-glucose co-transporter 2 (SGLT-2) inhibitors have the best mix of weight, blood pressure, and hypoglycemia reduction compared with other oral agents, but at the expense of more mycotic genital infections (SOR: C, disease-oriented evidence from meta-analyses of RCTs). Sulfonylureas, dipeptidyl peptidase-4 (DPP-4) inhibitors, thiazolidinediones, and SGLT-2 inhibitors are all feasible options. The choice of which 1 of these agents should take into account the benefits, adverse effects, and cost (SOR: C, expert opinion).

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