This study is a 24-week, phase 3, randomised, multicentre, double-blind, international trial comparing two doses of saxagliptin/glyburide vs increasing doses of glyburide alone. The final dose of glyburide was similar in the two combination groups (7 mg/day) and about half that in the glyburide monotherapy group. A1c was reduced in both combination groups (0.54% and 0.64%) but essentially unchanged in the glyburide group. The percent of people attaining an A1c goal of <7% was low in all three groups, but better in the combination groups. The incidence of side effects was low. However, hypoglycemia was fairly high at 10% in the glyburide group and around 14% in the combination groups. The authors conclude that they “demonstrated that in patients with type 2 diabetes not achieving glycaemic control on glyburide monotherapy, the addition of saxagliptin once daily to submaximal doses of glyburide for 24 weeks provided statistically significant and clinically meaningful reductions in key parameters of glycaemic control vs. uptitrated glyburide, without statistically significantly increasing the frequency of hypoglycaemia.” One could question whether decreasing an A1c from 8.4% to 7.8% is “clinically meaningful”. However, one could also argue that this would be a gentle first step toward a more complicated combination regimen involving at least 3-4 different glucose lowering agents. These data suggest that a different strategy is needed for people with the following characteristics: 55 y/o, 7 years of known diabetes, with an A1c of 8.4% on a submaximal dose of a sulfonylurea. Given that after 7 years of DM, beta-cell function is poor, it is no surprise that this strategy of combining two secretagogues, a DPP-4 inhbitor and an SU, did not provide much therapeutic benefit. The value of this study is that it provides data to convince practitioners to take a different approach in this type of patient. Kittie Wyne, MD, PhD, FACE