DPP-4 Inhibitors have established themselves in the treatment of diabetes, possibly because of their excellent tolerability. Sitagliptin has been extensively used in the USA and vildagliptin in several other countries. Saxagliptin is another DPP-4 I that has been approved in the US and is now commercially available. This study demonstrates that saxagliptin is effective as a first line therapy in type 2 diabetes. While most guidelines recommend metformin as first line therapy, several patients cannot tolerate that drug and it is contraindicated in others. Thus saxagliptin may be a good alternative that in this study was effective and well tolerated. Saxagliptin demonstrated statistically significant decreases in adjusted mean HbA(1c) changes from baseline (mean, 7.9%) to week 24 (-0.43%, -0.46%, -0.54%) for saxagliptin 2.5, 5, and 10 mg, respectively, vs. +0.19% for placebo (all p < 0.0001). However, long term safety data is lacking and studies on outcomes are needed. Vivien Fonseca, MD