DPP4 and Hyperglycemia: However, in line with expert recommendations (24), which suggest stepwise management of pasireotide-associated hyperglycemia with metformin followed by the sequential addition of a DPP-4 inhibitor, glucagon-like peptide 1 (GLP-1) agonist and insulin, metformin (39% of patients) and DPP-4 inhibitors (19% of patients) were the most frequently used antidiabetic medications in this study.