The glifozins do not arrange the metabolism in the diabetic patient, only lows glycose loosing it in the urine. Is a "cosmetic" treatment: Low blood level of glycose, subsequently diminishes HbA1c, bat the patient cells are in a hungry of glycose. The patient cells patient are in that way, no correctly feedded, a great quantity of carbohydrates (CH) is lost in the orine, feeding the urinary bacteries and increasing the risk and incidence of urinary tract infections, in this CH urinary concentration and bad metabolic status, caused by the diminishement of entering glucose in the cells ( I remember you that in diabetes the CH concentration is higer more than enogh in blood but cannot entering in the cells , which are in a hungry of glucose ) kydney necrosis papilar risk is evidently increased and it constitute a very serious complication of diabetes.
The DPP-4 inhibitorsare are, of couse, better option and the sulfonil ureas also and obove all Metformin, Nevertheless the Glinides are in many cases enough.However the Metformin solves the problem the most of cases, especially if obesity is praesent. All is depending on the type of patient, we know insulin is the best in many type2 patients, when the beta cells are exhausted.