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Patients with indicators of high-risk or established ASCVD, chronic kidney disease, or heart failure According to the ADA, when considering an agent for add-on to metformin background therapy, the first recommended consideration is whether or not the patient has indicators of high-risk or established ASCVD, chronic kidney disease (CKD), or heart failure ( Figure 2 )

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NICE Guidelines on Using DPP-4 Inhibitors in Type 2 Diabetes NICE NG28 recommends DPP-4 inhibitors as second- or third-line therapy alongside metformin, particularly when hypoglycaemia risk or weight gain is a concern, but prioritises SGLT-2 inhibitors in patients with cardiovascular disease or chronic kidney disease

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