The lack of a clear scientific rationale combined with apparently contradictory reasoning underlying the benefit assessments of two diabetes drugs in Germany could leave patients with few choices: make do with metformin or sulfonylureas, go on insulin, or cross the border to buy newer drugs out of pocket.

On Feb. 21, the German Federal Joint Committee (G-BA) released a final assessment of Trajenta linagliptin that waved aside clear benefits on weight and hypoglycemia - and signals of cardiovascular benefit - to conclude the dipeptidyl peptidase-4 (DPP-4) inhibitor was no better than sulfonylureas.