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Comment on Zhang et al. Second-Line Agents for Glycemic Control for Type 2 Diabetes: Are Newer Agents Better? Diabetes Care 2014;37:1338–1345

We read with great interest the article by Zhang et al. (1) in which they compared in a model four second-line treatment strategies following metformin monotherapy: sulfonylurea, dipeptidyl peptidase-4 inhibitor, GLP-1 agonist, and insulin. They concluded that all strategies produced similar glycemic benefits, but favored sulfonylurea from a treatment cost perspective. Diabetes models are used to simulate outcomes that cannot be directly observed during clinical trials. The results are often used by payers to inform formulary decisions and, as such, diabetes models play an increasingly important role on the availability of therapeutic options to both patients and prescribers. …