What is the first-line agent in the described type 2 diabetes treatment plan?

What is the first-line agent in the described type 2 diabetes treatment plan?

• A. Insulin
• B. SGLT inhibitors
• C. GLP-1 receptor agonists
• D. Metformin

Answer: (D)

Metformin is chosen first because it effectively lowers glucose with a low risk of causing hypoglycemia, while also offering potential weight benefits and a strong safety and cost profile. It works primarily by decreasing hepatic glucose production and improving insulin sensitivity, often lowering A1C by about 1–2% as monotherapy. Its long track record includes cardiovascular benefit signals in overweight individuals, and it is inexpensive and widely available. Start at a low dose with meals to minimize gastrointestinal side effects, and monitor kidney function since metformin is contraindicated or requires adjustment at reduced eGFR levels. If metformin isn’t suitable or enough, other agents can be added based on the patient’s needs and comorbidities.

Metformin is chosen first because it effectively lowers glucose with a low risk of causing hypoglycemia, while also offering potential weight benefits and a strong safety and cost profile. It works primarily by decreasing hepatic glucose production and improving insulin sensitivity, often lowering A1C by about 1–2% as monotherapy. Its long track record includes cardiovascular benefit signals in overweight individuals, and it is inexpensive and widely available. Start at a low dose with meals to minimize gastrointestinal side effects, and monitor kidney function since metformin is contraindicated or requires adjustment at reduced eGFR levels. If metformin isn’t suitable or enough, other agents can be added based on the patient’s needs and comorbidities.