Due to increased risk of cardiovascular events, thiazolidinedione use has diminished in the past decade, and use of the other agents has increased.10,11 Specifically, costs associated with increased use of DPP-4 inhibitors, SGLT2 inhibitors, and GLP-1 receptor agonists has risen from $10 billion to $22 billion from 2002 to 2012.12 In addition, due to its progressive nature, many patients with T2D eventually require and benefit from insulin therapy, usually in combination with metformin. Here, DPP4 is linked to type 2 diabetes mellitus.