Maxed Out on Metformin—Now What? Individualized Diabetes Management

Activity Preview

Over the past few decades, the understanding of diabetes pathophysiology and the pharmacotherapy armamentarium have rapidly expanded. It is now widely accepted that diabetes is a complex, multi-organ, chronic disease that requires continuous medical and educational care. Treatment with metformin is recommended as initial therapy for most patients with type 2 diabetes. However, metformin alone is insufficient for achieving and maintaining blood glucose goals for many patients. Most patients require  additional therapy, particularly as the disease progresses. For second-line therapy, ADA recommends six treatment options for clinicians to choose from: sulfonylureas, thiazolidinediones, DPP-4 inhibitors, SGLT-2 inhibitors, GLP-1 agonists, and basal insulin. Identifying the most appropriate therapies to add for an individual patient can be a daunting task.



Learning Objectives

After participating in this activity, the pharmacist will be able to:

  1. Review updates to the 2016 American Diabetes Association’s Standards of Medical Care in Diabetes.
  2. Describe the mechanism of action and unique features of the various classes of medications recommended as second-line therapies for type 2 diabetes.
  3. Discuss contraindications and adverse effect considerations when recommending second-line therapies for type 2 diabetes.
  4. Given a case in which the patient has reached the maximal effective dosage of metformin, select among available treatment options for add-on therapy.

Activity type: Knowledge-based
Learning Level: 2


Accreditation Information

ACPE logo

The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

To obtain 2.0 contact hours of continuing pharmacy education credit (0.2 CEUs) for completing "Maxed Out on Metformin—Now What? Individualized Diabetes Management," complete the CPE examination and evaluation questions. Credit will be awarded upon achieving a passing grade of 70% or better. Please visit CPE Monitor for your statement of credit/transcript.

APhA continuing pharmacy education policy provides you with two opportunities to successfully complete this continuing pharmacy education examination. Please note that you will not be permitted to submit the examination a third time. Exam questions may not appear in the same order as printed.

The current policy of the APhA Education Department is not to release the correct answers to any of our CPE tests. This policy is intended to maintain the integrity of the CPE activity and the test. Individuals completing this activity by August 1, 2019 can receive credit.

Initial release date: August 1, 2016
Expiration date: August 1, 2019
ACPE Universal Activity Number: 0202-0000-16-141-H01-P


Advisory Board

Jennifer Trujillo, PharmD, BCPS, CDE, BC-ADM
Associate Professor
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences.



Jennifer Trujillo, PharmD, BCPS, CDE, BC-ADMdeclares that she is a consultant for Sanofi. Susan Cornell, PharmD, CDE, FAPhA, FAADE, and APhA’s editorial staff declare no conflicts of interest or financial interests in any product or service mentioned in this activity, including grants, employment, gifts, stock holdings, and honoraria.. For complete staff disclosures please see the APhA Accreditation Information section at



"Maxed Out on Metformin—Now What? Individualized Diabetes Management” is a home-study continuing education activity for pharmacists developed by the American Pharmacists Association.


Activity Fee

There is no fee associated with this activity for members of the American Pharmacists Association. There is a $25 fee for nonmembers.

Credit Information

Activity Number Credit Amount Accreditation Period
ACPE# 0202-0000-16-141-H01-P 0.2 CEUs August 01, 2016 - August 01, 2019