Abstract : SUMMAR Y : Patients with type 2 diabetes should improve lifestyle habits combined with metformin as first pharmacological compound (in absence of contra-indications). In case of failure of metformin monotherapy (due to the progression of the disease secondary to B-cell exhaustion), another oral glucose-lowering agent should be added. Several medications may be used, with some advantages and disadvantages for each of them. The present clinical case illustrates this dilemma and should help the reasoning leading to the best pharmacological combination according to individual patient’s profile.