First-line pharmacotherapy for type 2 diabetes is

First-line pharmacotherapy for type 2 diabetes is

• A. Insulin
• B. Sulfonylurea
• C. Metformin
• D. GLP-1 receptor agonist

Answer: (C)

Metformin is chosen first because it lowers glucose mainly by reducing hepatic glucose production and by improving insulin sensitivity in liver and muscle, without forcing more insulin release. This means you get better blood sugar control with a low risk of hypoglycemia and often with neutral or modest weight loss. It’s inexpensive and has a long track record of safety, including cardiovascular benefits in some studies. Because of these advantages, guidelines recommend metformin as the initial drug therapy alongside lifestyle changes, provided there are no contraindications such as significant kidney or liver disease or a high risk of lactic acidosis. Insulin is typically reserved for people with very high blood glucose, poor beta-cell function, or when other therapies aren’t enough, because it requires injections and carries higher risks of hypoglycemia and weight gain. Sulfonylureas stimulate insulin release, but they can cause hypoglycemia and weight gain, making them less favorable as initial therapy. GLP-1 receptor agonists can improve glucose control and promote weight loss, and they have cardiovascular benefits, but they are injectable and usually more costly, which is why they aren’t first-line.

Metformin is chosen first because it lowers glucose mainly by reducing hepatic glucose production and by improving insulin sensitivity in liver and muscle, without forcing more insulin release. This means you get better blood sugar control with a low risk of hypoglycemia and often with neutral or modest weight loss. It’s inexpensive and has a long track record of safety, including cardiovascular benefits in some studies. Because of these advantages, guidelines recommend metformin as the initial drug therapy alongside lifestyle changes, provided there are no contraindications such as significant kidney or liver disease or a high risk of lactic acidosis.

Insulin is typically reserved for people with very high blood glucose, poor beta-cell function, or when other therapies aren’t enough, because it requires injections and carries higher risks of hypoglycemia and weight gain. Sulfonylureas stimulate insulin release, but they can cause hypoglycemia and weight gain, making them less favorable as initial therapy. GLP-1 receptor agonists can improve glucose control and promote weight loss, and they have cardiovascular benefits, but they are injectable and usually more costly, which is why they aren’t first-line.