Dear Renu i can understand your concern in my opinion the fasting blood sugar is not under control in this kind of scenario we need to go for combination medication.when cost is a factor the best combination will be metformin and sulphonylurea drugs. Usually the first line of medication in diabetes is called as metformin. which is a very good medication and are having very good benefits like 1,sugar control 2,control cholesterol to certain extent 3,weight reduction 4,modulation of satiety 5,protect liver from getting fatty acids deposition. i understand that januvia is expensive but the similar molecules like jalra,onglyza and traceba are also of same cost. since this markets are slightly new to the market they are still under patent rights once this molecules comes to generic the cost will come down. As a diabetic drugs this medicine januvia is a very good drug. regards Dr vamsi Diabetologist