12 minutes to Read While metformin remains the preferred first-line pharmacological treatment for type 2 diabetes, empagliflozin and dulaglutide may replace sulphonylureas as second-line agents Diabetes clinical nurse specialist Lisa Sparks discusses the place of empagliflozin and dulaglutide in treatment of type 2 diabetes, with emphasis on potential side effects, sick-day management and improving patient adherence Type 2 diabetes affects a large number of New Zealanders. According to national dispensing data, about 220,000 people aged ≥ 25 received oral hypoglycaemic agents and/or insulin between October 2019 and September 2020. 1 Generally, type 2 diabetes begins with a degree of insulin resistance but, over time, becomes a disease of insulin deficiency due to progressive pancreatic beta cell exhaustion. Metabolic, inflammatory and oxidative processes as well as glucose toxicity, lipotoxicity and hereditary factors underlie the disease pathogenesis.