Drugs in diabetes in 2016, changes in endocrinology in 2015. Dr. Hertzel Gerstein in an interview with Dr. Roman Jaeschke.

That was all there was. Now we have 12 class‐ es in the United States—in other countries it is about 10 or 11. That to me is wonderful; it means that we have choice and it means that we can tai‐ lor more the therapy to the individual patients that we have. Several of the drugs we have cause weight loss as a side effect: actually 2 of them, sodium ‐glucose cotransporter 2 (SGLT2) inhibi‐ tors and the glucagon ‐like peptide (GLP)‐1 recep‐ tor agonists do have a weight loss effect. Many of the drugs do not cause hypoglycemia and very few cause weight gain now. The only drugs that cause a little bit of weight gain are sulfonylureas and insulin, and thiazolidinediones, which are not used that often today. I think most people would not argue that unless there was a contra‐ indication or people could not tolerate the drug, people today should probably be taking metfor‐ min as an agent for diabetes for lots of reasons, including its long safety record, the fact that it may be associated with a lower risk of cardiovas‐ cular events and other outcomes, and that it has really proven itself over the years. After that, I think it depends on how hyper‐ glycemic the patient is and what their comorbidi‐ ties are. If they have renal failure, you cannot use many drugs; if they have a very low glomerular filtration rate (GFR), insulin is probably the only safe drug to use for people with a low GFR. If they are very hyperglycemic, you are probably wise to start with insulin right away or in addition to met‐ formin because you have to lower their blood glu‐ cose levels and get them down quickly; if they are at high cardiovascular risk, I think empagliflozin is a reasonable drug. If weight loss is an impor‐ tant criterion, then one can consider GLP ‐1 recep‐ tor agonist plus empagliflozin. If they had previ‐ ous pancreatitis, then you would not want to use the drugs that have concerns about pancreatitis, like the incretins‐ipeptidyl peptidase ‐4 (DPP ‐4) inhibitors. So I guess I do not have an easy an‐ swer for the question. There are also issues of In a previous interview,1 you told us about empagliflozin. How about the other classes of drugs used in the treatment of type 2 diabetes? Which one would you say we use—I do not know whether it could be said—routinely, regularly? I know already that there is no such thing as an average patient.