The combination of metformin and a sulfonylurea is commonly used in type 2 
diabetes mellitus. Many patients on this combination therapy do not achieve or 
maintain glycemic targets and require the addition of a third antihyperglycemic 
agent. Among the options are the sodium glucose cotransporter 2 (SGLT2) 
inhibitors, a recently developed class of medications that effectively improve 
glycemic control and are associated with reduction in body weight and blood 
pressure. This article evaluates a 24-week, randomized, placebo-controlled study 
of the SGLT2 inhibitor empagliflozin, added to metformin plus sulfonylurea 
regimens. Empagliflozin led to significant reductions in glycated hemoglobin and 
fasting plasma glucose, as well as body weight and systolic blood pressure. 
Adverse events typically recorded with SGLT2 inhibitors were observed; notably, 
genital infections occurred in more patients on empagliflozin than placebo. 
Overall, empagliflozin was well tolerated. These results indicate that SGLT2 
inhibitors can be successfully added to metformin plus sulfonylurea regimens. 
SGLT2 inhibitors are not the only therapeutic option in this clinical situation; 
however, based on the secondary effects observed in this and other studies, they 
appear to be of particular value for patients who are obese or overweight.