There continues to be good evidence of the effectiveness of these treatments so they are included in the NICE guideline, although appropriate monitoring for side effects is always recommended. 

Ideally, for any blood glucose lowering medicine, you want to see a reduction in HbA1c, no hypoglycaemia, minimal side effects and low acquisition cost. In the absence of this perfect medicine, it becomes necessary to prioritise the relevant factors and to establish the compromises that can be made. 

There is no one option that will be perfect for all patients all of the time. The prescriber may need to consider changes to the regimen over time, particularly if a patient stops responding, develops side effects or comorbidities, or perhaps if a new medicine becomes available. This may include stopping medicines if they no longer appear to be effective and confirming adherence at every review.