INS and diabetes mellitus: A recent statement of Standards of Medical Care in Diabetes by the American Diabetes Association (ADA) has recommended that initial treatment with metformin as monotherapy after inadequate life style modification, followed by sulfonylurea, thiazolidinedione, dipeptidyl peptidase-4 (DPP-4) inhibitor, sodium-glucose cotransporter 2 inhibitor (SGLT2-i), glucagon-like peptide 1 (GLP-1) receptor agonist and insulin alone or in combination (American Diabetes Association, 2017).